title: Comparison of one-year prognosis of patients classified as chronic critical lower limb ischaemia according to TASC II or European consensus definition in the COPART cohort.
abstract: BACKGROUND
  We compared one-year amputation and survival rates in patients fulfilling 1991 European consensus critical limb ischaemia (CLI) definition to those clas, sified as CLI by TASC II but not European consensus (EC) definition.
  
  
  METHODS
  Patients were selected from the COPART cohort of hospitalized patients with peripheral occlusive arterial disease suffering from lower extremity rest pain or ulcer and who completed one-year follow-up. Ankle and toe systolic pressures and transcutaneous oxygen pressure were measured. The patients were classified into two groups: those who could benefit from revascularization and those who could not (medical group). Within these groups, patients were separated into those who had CLI according to the European consensus definition (EC + TASC II: group A if revascularization, group C if medical treatment) and those who had no CLI by the European definition but who had CLI according to the TASC II definition (TASC: group B if revascularization and D if medical treatment).
  
  
  RESULTS
  471 patients were included in the study (236 in the surgical group, 235 in the medical group). There was no difference according to the CLI definition for survival or cardiovascular event-free survival. However, major amputations were more frequent in group A than in group B (25 vs 12 %, p = 0.046) and in group C than in group D (38 vs 20 %, p = 0.004).
  
  
  CONCLUSIONS
  Major amputation is twice as frequent in patients with CLI according to the historical European consensus definition than in those classified to the TASC II definition but not the EC. Caution is required when comparing results of recent series to historical controls. The TASC II definition of CLI is too wide to compare patients from clinical trials so we suggest separating these patients into two different stages: permanent (TASC II but not EC definition) and critical ischaemia (TASC II and EC definition).
authors.affiliation: 1 Medecine Vasculaire, Hopital St Andre, Bordeaux, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Vircoulon
authors.forename: Carine
authors.initials: C
authors.lastname: Boulon
authors.forename: Ileana
authors.initials: I
authors.lastname: Desormais
authors.forename: Philippe
authors.initials: P
authors.lastname: Lacroix
authors.forename: Victor
authors.initials: V
authors.lastname: Aboyans
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bura-Riviere
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cambou
authors.forename: François
authors.initials: F
authors.lastname: Becker
authors.forename: Joel
authors.initials: J
authors.lastname: Constans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D032921:Consensus; D016638:Critical Illness; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D007511:Ischemia / Q000145:classification / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012086:Reoperation; D009626:Terminology as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
chemical_list: D002317:Cardiovascular Agents
keywords: Peripheral occlusive arterial disease; amputation; critical limb ischaemia; definition; prognosis