Results and resource implications of treating end-stage limb ischaemia.
OBJECTIVE
To quantitate the workload, resource requirement and outcome involved in the management of patients with chronic limb-threatening ischaemia when adopting an aggressive reconstructive policy.


METHODS
Prospective clinical audit of all patients with severe lower limb ischaemia presenting to a single specialist Vascular Surgeon in a 3 year period.


RESULTS
A total of 228 patients were treated with 275 severely ischaemic limbs. Two hundred and thirty-five limbs (85.5%) had procedures to improve blood supply, 19 (6.9%) underwent primary amputation and 21 (7.7%) were treated conservatively. The principal outcome measures were limb-salvage, death and graft patency. The cumulative limb-salvage, including those undergoing primary amputation, at 30 days, 1, 2, 3 and 4 years was 94.2%, 82.7%, 73.1%, 68.3% and 65.3% respectively. The cumulative patient survival was 91.7%, 69.2%, 58.1%, 47.9% and 40.6% for the same intervals. For reconstructive vascular surgery, excluding amputation and rehabilitation, a total of 383 hospital admissions were required covering 7343 hospital days, 64.5% of patients were managed in a single admission. The median duration of stay was 16 days for the first admission. Operations included 361 separate procedures to improve blood supply and 70 major limb amputations.


CONCLUSIONS
The management of chronic limb-threatening ischaemia presents major resource implications. An acceptable limb-salvage rate can be achieved although there is a high initial mortality. In view of the poor overall survival any benefits for these patients should be viewed as relatively short-term objectives.
Holdsworth
R J
RJ
Department of Vascular Surgery, Ninewells Hospital, Dundee, U.K.
McCollum
P T
PT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D007902:Length of Stay; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures