Improving limb salvage rate in diabetic patients with critical leg ischaemia using a multidisciplinary approach.
BACKGROUND
Diabetic patients are more likely to develop critical leg ischaemia (CLI) and subsequently major amputation than the general population. Major amputation rate in this group is reported to be high compared with non-diabetic patients with a devastating outcome.


OBJECTIVE
The aim of this study was to assess the impact of a multidisciplinary approach on the major amputation rate in diabetic patients with CLI suitable for surgical or radiological revascularisation.


METHODS
A retrospective analysis of data of all diabetic patients with CLI presenting to a one-stop multidisciplinary clinic between December 2003 and May 2006 was performed. The multidisciplinary team included a vascular surgeon, diabetologist, podiatrist, tissue viability nurse, interventional radiologist and a radiology coordinator. Peripheral vascular disease was assessed by history taking, clinical examination, ankle brachial pressure index, Doppler arterial waveform analysis and transcutaneous oxygen tension. Duplex scan and magnetic resonance angiography were performed in selected patients. Based on the available information, suitable patients were offered percutaneous transluminal angioplasty (PTA), surgical arterial reconstruction (SAR) or both (hybrid arterial reconstruction).


RESULTS
Three hundred and twelve diabetic patients with CLI were suitable for revascularisation. Eighty-two per cent underwent PTA while 18% underwent SAR. Thirteen threatened grafts were detected during follow-up and early intervention was performed as required. Major amputation rate among the study group was 4.1%.


CONCLUSIONS
Multidisciplinary approach improves the care of diabetic patients with CLI. Close follow-up and early intervention in dedicated centres improve limb salvage rates in this group of high-risk patients.
Zayed
H
H
Departments of Vascular Surgery, Internal Medicine and Interventional Radiology, King's College Hospital NHS Foundation Trust, London, UK.
Halawa
M
M
Maillardet
L
L
Sidhu
P S
PS
Edmonds
M
M
Rashid
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents