title: Long-term clinical outcomes in critical limb ischemia--A retrospective study of 181 patients.
abstract: OBJECTIVE
  Critical limb ischemia (CLI) is the most severe manifestation of the peripheral arterial disease. To date, several prognostic factors have been identified but the data of long-term follow-up in real life setting are scarce. The aim of our study is to describe a large group of CLI patients and identify possible prognostic factors, in a long-term follow-up.
  
  
  METHODS
  Case-control, retrospective study. 181 consecutive CLI patients with a minimum follow-up of 5 years were included in the study.
  
  
  RESULTS
  Overall mortality was 15%, 24%, and 43% at 1, 2, and 5 years, respectively. Among known risk factors, only arterial hypertension was significantly correlated with survival rate; no differences were found between diabetics and non-diabetics. Patients treated with intravenous iloprost (46%), compared to untreated patients, showed a better (p < 0.0001) long-term outcome in terms of major amputation (6% vs. 21%), subsequent vascular surgery (4% vs. 32%) and survival rates (69% vs. 47%), at 5-year follow-up. Major amputations were significantly correlated with lower median forefoot transcutaneous values of O2 (0/3 mmHg, p < 0.001) and higher median values of CO2 (83/53 mmHg, p < 0.0001) in supine/dependent position, respectively.
  
  
  CONCLUSIONS
  Our results confirm the poor prognosis of CLI patients in a very long-term follow-up and the severe metabolic damage caused by ischemia. A favourable role of iloprost was observed, in agreement with previous evidence in the literature.
authors.affiliation: Angiology Unit, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy. a.farina@italfarmaco.com.
authors.forename: E
authors.initials: E
authors.lastname: Melillo
authors.forename: L
authors.initials: L
authors.lastname: Micheletti
authors.forename: M
authors.initials: M
authors.lastname: Nuti
authors.forename: G
authors.initials: G
authors.lastname: Dell'Omo
authors.forename: R
authors.initials: R
authors.lastname: Berchiolli
authors.forename: D
authors.initials: D
authors.lastname: Adami
authors.forename: A
authors.initials: A
authors.lastname: Farina
authors.forename: G
authors.initials: G
authors.lastname: Panigada
authors.forename: S
authors.initials: S
authors.lastname: Meini
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality / Q000639:trends; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends