title: Conservative Treatment in Selected Patients with Severe Critical Limb Ischemia.
abstract: OBJECTIVE
  To assess the outcome of conservative treatment of severe critical limb ischemia (CLI) classified as Rutherford 5/6.
  
  
  BACKGROUND
  The preferred therapy for CLI is either endovascular revascularization or bypass surgery. With a growing aged population with more serious comorbidities, these therapies are not always a viable option. Primary amputation leads to decreased mobility and a reduced quality of life. There is a lack of literature regarding the outcome of conservative therapy.
  
  
  METHODS
  Hospital charts were reviewed of all patients who were diagnosed with Rutherford classification 5-6 and received conservative treatment and lacked interventional options. Outcome measures were mortality, complete wound closure, and limb salvage rate.
  
  
  RESULTS
  38 patients were included with a median age of 80 years (range 57-97). The amputation rate during follow-up was 16%. In 58% of patients, complete wound closure was achieved. All-cause mortality was 58% with a 2-year survivability rate of 55%.
  
  
  CONCLUSIONS
  Conservative management in our selected patients with CLI results in a moderate rate of wound closure and acceptable amputation rates albeit with a high mortality rate. For patients not eligible for endovascular revascularization or bypass surgery, conservative treatment could be a viable option besides primary limb amputation.
authors.affiliation: Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands, rthomas@amphia.nl.
authors.forename: Adriaan R
authors.initials: AR
authors.lastname: Thomas
authors.forename: Jelle W
authors.initials: JW
authors.lastname: Raats
authors.forename: Mare M A
authors.initials: MM
authors.lastname: Lensvelt
authors.forename: Hans G W
authors.initials: HG
authors.lastname: de Groot
authors.forename: Eelco J
authors.initials: EJ
authors.lastname: Veen
authors.forename: Lijckle
authors.initials: L
authors.lastname: van der Laan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001458:Bandages; D015331:Cohort Studies; D015897:Comorbidity; D003646:Debridement; D005260:Female; D005734:Gangrene / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D007871:Leg Ulcer / Q000209:etiology / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D059408:Pain Management; D018579:Patient Selection; D058729:Peripheral Arterial Disease / Q000150:complications / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000209:etiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents