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Chronic critical leg ischaemia must be redefined
M M Thompson1, R D Sayers, K Varty
1Department of Surgery, Leicester Royal Infirmary, U.K.
European Journal of Vascular Surgery
|July 1, 1993
Summary
The current definition for critical limb ischaemia (CLI) may not accurately predict outcomes. Many patients with severe lower limb ischaemia and poor outcomes do not meet the established ankle systolic pressure criteria.
Area of Science:
- Vascular Surgery
- Clinical Medicine
- Medical Diagnostics
Background:
- Critical limb ischaemia (CLI) is defined by the European Consensus Document based on ankle systolic pressure (ASP) or toe pressure.
- This definition is crucial for guiding clinical decisions in managing severe lower limb ischaemia.
Purpose of the Study:
- To evaluate the predictive accuracy of the current European definition of CLI in non-diabetic patients.
- To assess the clinical relevance of the established ASP thresholds for predicting limb salvage and mortality.
Main Methods:
- Analysis of 148 severely ischaemic limbs in 133 non-diabetic patients presenting with rest pain or tissue necrosis.
- Comparison of limb salvage and mortality rates between patients meeting the ASP ≤ 50 mmHg definition and those with ASP > 50 mmHg.
Main Results:
- 51% of analyzed limbs met the ASP ≤ 50 mmHg criterion for CLI.
- No significant differences in 1-year limb salvage (78.7% vs. 73.9%) or mortality (36.7% vs. 17.3%) rates were observed between the groups.
- A significant portion of patients with poor outcomes did not meet the current CLI definition.
Conclusions:
- The current European definition of CLI based on ASP may not adequately identify all patients at high risk for adverse outcomes.
- Re-evaluation of the definition is warranted to improve clinical practice and patient stratification for severe lower limb ischaemia.