Clinical outcomes using aggressive approach to anatomic screening and endovascular revascularization in a veterans affairs population with critical limb ischemia.
BACKGROUND
This study sought to examine the impact of an aggressive approach to anatomic screening and endovascular revascularization in a veterans administration population with critical limb ischemia (CLI) on the primary treatments received and overall clinical outcomes.


METHODS
The baseline clinical and angiographic characteristics and clinical outcomes of the first consecutive fifty veterans who were referred for the evaluation and treatment of CLI using the strategy outlined were assessed by retrospective review of the computerized medical record and angiographic data.


RESULTS
Among the entire cohort, the primary treatments received were as follows--revascularization n = 44 (88%), primary amputation n = 1 (2%), medical treatment n = 3 (6%), and primary minor amputation n = 2 (4%). Endovascular revascularization was the dominant mode of revascularization (94%), with a procedural success rate of 91%. Repeat revascularization was required in 19% of patients who had an initially successful endovascular procedure. A total of eight deaths and four major amputations occurred in the entire cohort over a mean follow-up of 397 +/- 190 days. The 1-year Kaplan-Meier estimates for survival and amputation-free survival for the entire cohort were 90 and 81%, respectively. Resolution of rest pain or complete wound healing was achieved in 85% of patients at a mean of 157 +/-126 days.


CONCLUSIONS
An aggressive approach to anatomic screening and contemporary endovascular treatment of CLI resulted in a higher rate of revascularization as the primary treatment for CLI than previously reported, and was associated with high rates of overall and amputation-free survival.
Shah
Alap P
AP
Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA.
Klein
Andrew J
AJ
Sterrett
Andrew
A
Messenger
John C
JC
Albert
Stephen
S
Nehler
Mark R
MR
Hiatt
William R
WR
Casserly
Ivan P
IP
D000368:Aged; D000671:Amputation, Surgical / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016638:Critical Illness; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D018810:Magnetic Resonance Angiography; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014945:Wound Healing
D002317:Cardiovascular Agents