Nonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage.
Critical limb ischemia (CLI) patients are at high risk of primary amputation. Using a sequential compression biomechanical device (SCBD) represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality. Thirty-five patients with 39 critically ischemic limbs (rest pain = 12, tissue loss = 27) presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment. The mean follow-up was 10 months (SD +/- 6 months). There were four amputations, with an 18-month cumulative limb salvage rate of 88% (standard error [SE] +/- 7.62%). Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mm Hg (SD +/- 33.7, 95% confidence interval [CI] 55-79). Popliteal artery flow velocity increased from 45 to 47.9 cm/s (95% CI 35.9-59.7). Cumulative survival at 12 months was 81.2% (SE +/- 11.1) for SCBD, compared with 69.2% in the control group (SE +/- 12.8%) (p = .4, hazards ratio = 0.58, 95% CI 0.15-2.32). The mean total cost of primary amputation per patient is euro29,815 ($44,000) in comparison with euro13,900 ($20,515) for SCBD patients. SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.
Sultan
Sherif
S
Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Galway, Ireland. sherifsultan@esatclear.ie
Esan
Olubunmi
O
Fahy
Anne
A
D000368:Aged; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000191:economics / Q000628:therapy; D001783:Blood Flow Velocity; D017024:Chemotherapy, Adjuvant; D004812:Epidemiologic Methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006439:Hemodynamics; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices / Q000191:economics; D007511:Ischemia / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D023821:Limb Salvage / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D011150:Popliteal Artery / Q000503:physiopathology; D014034:Toes / Q000098:blood supply; D016896:Treatment Outcome