title: Urgent endovascular revascularization in acute on chronic critical limb ischemia.
abstract: BACKGROUND
  The aim of this study was to evaluate early and one-year outcomes of urgent endovascular treatment in patients with acute on chronic critical limb ischemia (CLI).
  
  
  METHODS
  Between January 2012 and December 2013 104 patients with acute on chronic CLI (Rutherford class 4-6) were referred to two tertiary hospitals. In all cases the urgent endovascular revascularization was considered the first therapeutic option. Twenty-seven patients (26%) were excluded from this approach (long occlusion >30 cm of the femoro-popliteal tract and/or massive gangrene with abscess/osteomyelitis/necrotizing fasciitis).
  
  
  RESULTS
  Seventy-seven out of 104 patients received an urgent endovascular treatment. They were predominantly male (43, 55.8%) with a mean age of 76.5 years (range 47-94). In 67 cases (87%) the patients had leg/foot lesions (54, 70.1%, Rutherford class 5, and 13, 16.9%, Rutherford class 6). During the follow-up (mean duration 6.2 months, range 1-24 months) the healing of the lesions and the relief of rest pain were obtained in 46 cases (59.7%). Estimated one-year primary patency, primary assisted patency, secondary patency, and limb salvage rates were 63.6%, 68.3, 69%, and 84.1%, respectively. At uni- and multivariate analysis patients in Rutherford class 6 showed poor results in terms of primary patency, primary assisted patency, secondary patency, and limb salvage (P<0.001).
  
  
  CONCLUSIONS
  Urgent endovascular treatment in selected patients with acute on chronic CLI represents a safe and effective option with good results in terms of healing of the ischemic lesions, relief of rest pain, and limb salvage. Patients in Rutherford class 6 showed fewer benefits with this approach.
authors.affiliation: Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy - nicola.troisi@alice.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Troisi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ercolini
authors.forename: Emiliano
authors.initials: E
authors.lastname: Chisci
authors.forename: Enrico
authors.initials: E
authors.lastname: Barbanti
authors.forename: Elisa
authors.initials: E
authors.lastname: Peretti
authors.forename: Marco
authors.initials: M
authors.lastname: Setti
authors.forename: Antonino
authors.initials: A
authors.lastname: Pitì
authors.forename: Stefano
authors.initials: S
authors.lastname: Michelagnoli
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D002908:Chronic Disease; D016638:Critical Illness; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D007558:Italy; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency