Related Experiment Videos
A case for an aggressive reconstruction policy for CLI
1Surgical Department, Vaasa Central Hospital, Finland. michael.luther@pp.inet.fi
Insights
Chronic critical leg ischaemia (CLI), common in older adults with diabetes and cardiovascular disease, requires long infrainguinal bypasses. Arterial reconstructive surgery offers acceptable outcomes and is cost-effective for managing this condition.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Cardiovascular Disease
Background:
- Chronic critical leg ischaemia (CLI) is increasingly prevalent, particularly in the elderly population (over 65).
- Patients often present with multiple comorbidities, including diabetes and cardiovascular disease.
- Infrainguinal arterial disease is the primary pathology in most CLI cases.
Purpose of the Study:
- To review the epidemiology, risk factors, and treatment of chronic critical leg ischaemia.
- To evaluate the efficacy and outcomes of reconstructive arterial surgery for CLI.
- To assess the long-term quality of life and cost-effectiveness of surgical interventions.
Main Methods:
- Review of existing literature and clinical data on chronic critical leg ischaemia.
- Analysis of treatment strategies, focusing on long infrainguinal bypasses.
- Evaluation of morbidity, mortality, re-intervention rates, and long-term follow-up.
Main Results:
- Reconstructive arterial surgery for CLI can be performed with acceptable morbidity and mortality rates.
- Long infrainguinal bypasses are frequently required for successful treatment.
- Many patients necessitate re-interventions and regular follow-up care.
Conclusions:
- Surgical management of CLI can lead to a reasonable quality of life for most patients.
- Reconstructive surgery is a cost-effective approach, reducing long-term care costs associated with amputations.
- Adherence to regular follow-up and re-intervention protocols is crucial for optimal patient outcomes.
Abstract:
Chronic critical leg ischaemia (CLI) occurs with increasing frequency in the population. A main reason for this is the increasing proportion of elderly persons in the population. CLI mostly affects persons over the age of 65 and a substantial proportion of the patients are more than 80 years old. Most patients have multiple risk factors, the most frequent being diabetes and various manifestations of cardiovascular disease. The main arterial changes are found in infrainguinal arteries in three-quarters of the patients and in 25-50% of the patients CLI will also affect the other leg at some time. Long infrainguinal bypasses are necessary for a successful treatment in most cases. Despite problems, reconstructive arterial surgery can be performed with acceptable morbidity and mortality. Re-interventions are necessary for many patients and regular follow-up should be a part of the treatment. The clinical results can ensure that most patients will have a reasonable quality of life. For society, reconstructive surgery is cost-effective as it reduces costs for long term care that otherwise would have been necessary after amputations.