title: Critical limb ischaemia: initial treatment and predictors of amputation-free survival.
abstract: OBJECTIVE
  To evaluate initial treatment and risk factors for amputation-free survival in patients with critical limb ischaemia (CLI).
  
  
  METHODS
  Prospective clinical cohort study at a single vascular surgical centre in Germany.
  
  
  METHODS
  Data on 104 consecutive patients (115 ischaemic limbs) presenting with their first episode of CLI were collected prospectively over a 3-year period. Initial treatment was classified as conservative therapy, intervention, surgery, or major amputation. Patient co-morbidities were assessed by uni- and multivariate analysis to determine risk factors for limb salvage, survival and amputation-free survival.
  
  
  RESULTS
  Indications for treatment were rest pain in 27 (23.5%) and tissue loss in 88 (76.5%) limbs. Revascularisation was attempted in 65% of all limbs: 45% by intervention and 55% by surgery. In 9% primary amputation was necessary and 22% received conservative therapy. Median follow-up was 28 months (1-42). The 3-year limb salvage, patient survival, and amputation-free survival rates were 73%, 41%, and 31%, respectively. Diabetes, cardiac disease and renal insufficiency were associated with poor survival. Combined cardiac and renal disease adversely affected amputation-free survival (HR, 3.68; 95% CI, 1.51-8.94; P < 0.001).
  
  
  CONCLUSIONS
  At least two third of all patients presenting with CLI can be offered some type of direct revascularisation. In patients with major cardiac disease and renal insufficiency, a poor outcome in terms of amputation-free survival is to be anticipated.
authors: Department of Vascular and Endovascular Surgery, Military Hospital Ulm, Oberer Eselsberg 40, D-89081 Ulm/Donau, Germany. m-engelhardt@web.de
authors: M
authors: M
authors: Engelhardt
authors: J
authors: J
authors: Boos
authors: H
authors: H
authors: Bruijnen
authors: W
authors: W
authors: Wohlgemuth
authors: C
authors: C
authors: Willy
authors: M
authors: M
authors: Tannheimer
authors: K
authors: K
authors: Wölfle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000401:mortality; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D005858:Germany; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality