The fate of patients with critical leg ischemia.
In some highly specialized and aggressive units, 90% of patients with critical leg ischemia (CLI) will undergo some form of surgical or endovascular procedure; however, in most, the figure is nearer 50 to 60%. The primary amputation rate varies from around 10% to 40%. The mortality rate in these patients with standard therapy is around 20% at 1 year and between 40% and 70% at 5 years. Virtually all (95%) patients who present with ischemic gangrene, and 80% of those presenting with rest pain, are dead within 10 years. There appears to be a decline in overall major amputation rates associated with a corresponding increase in revascularizations. However, although technical advances may have resulted in a steadying or even decrease in amputations, comparisons of total amputations over a longer period suggest an increase, presumably attributable to an aging population. Some forward projections predict that major amputations will be doubled in the next 30 years.
Dormandy
J
J
Department of Vascular Surgery, St George's Hospital Medical School, London, England, United Kingdom.
Heeck
L
L
Vig
S
S
D000368:Aged; D000671:Amputation, Surgical / Q000401:mortality* / Q000706:statistics & numerical data; D002986:Clinical Trials as Topic; D016638:Critical Illness / Q000401:mortality; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D015996:Survival Rate