Sequential compression biomechanical device versus primary amputation in patients with critical limb ischemia.
BACKGROUND
Patients with critical limb ischemia (CLI), who are unsuitable for intervention, face the consequence of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients.


OBJECTIVE
To assess the outcome of SCBD in patients with severe CLI who are unsuitable for revascularization. Primary end points were limb salvage and 30-day mortality.


METHODS
From 2005 to 2012, 189 patients with severe CLI were not suitable for revascularization. In all, 171 joined the SCBD program. We match controlled 75 primary amputations.


RESULTS
All patients were Rutherford category 4 or higher. Sustained clinical improvement was 68% at 1 year. Mean toe pressure increased from 19.9 to 35.42 mm Hg, P < .0001. Mean popliteal flow increased from 35.44 to 55.91 cm/sec, P < .0001. The 30-day mortality was 0.6%. Limb salvage was 94% at 5 years. Freedom from major adverse clinical events was 62.5%. All-cause survival was 69%. Median cost of managing a primary amputation patient is €29,815 compared to €3,985 for SCBD. We treated 171 patients with artassist at a cost of €681,965. However, primary amputation for 75 patients cost €2,236,125.


CONCLUSIONS
The SCBD therapy is a cost-effective and clinically effective solution in patients with CLI having no option of revascularization. It provides adequate limb salvage while providing relief of rest pain without any intervention.
1Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital, Galway (UCHG), Galway, Ireland.
Wael A
WA
Tawfick
Nader
N
Hamada
Esraa
E
Soylu
Anne
A
Fahy
Niamh
N
Hynes
Sherif
S
Sultan
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D016638:Critical Illness; D004867:Equipment Design; D005121:Extremities / Q000098:blood supply*; D005260:Female; D017048:Health Care Costs; D006439:Hemodynamics; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices / Q000191:economics; D007511:Ischemia / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
CLI; SCBD; amputation; artassist; critical limb ischemia