The efficacy of a multidisciplinary team approach in critical limb ischemia.
The aim of the present study was to clarify the characteristics of Japanese critical limb ischemia (CLI) patients and analyze the rates of real-world mortality and amputation-free survival (AFS) in all patients with Fontaine stage IV CLI who were treated with/without revascularization therapy by an intra-hospital multidisciplinary care team. All consecutive patients who presented with CLI at Showa University Fujigaoka Hospital between April 2008 and March 2014 were prospectively registered. The intra-hospital committee consisted of cardiologists, plastic surgeons, dermatologists, diabetologists, nephrologists, cardiovascular surgeons, and vascular technologists. The primary endpoint of this study was all-cause mortality and AFS during the follow-up period. The present study included 145 patients with Fontaine stage IV CLI. The mean age was 76.5 ± 10.2 years. The all-cause mortality rate during the follow-up period (15.5 ± 16.1 months) was 21.4 %. The AFS rate during the follow-up period (14.1 ± 16.4 months) was 58.6 %. A multivariate Cox proportional hazards regression analysis found that age >75 years and hemodialysis were significantly associated with all-cause mortality; and that age >75 years, Rutherford 6, and wound infection were significantly associated with AFS. A multidisciplinary approach and comprehensive care may improve the outcomes and optimize the collaborative treatment of CLI patients. However, all-cause mortality remained high in patients with Fontaine stage IV CLI and early referral to a hospital that can provide specialized treatment for CLI, before the occurrence of major tissue loss or infection, is necessary to avoid primary amputation.
Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan. hrsuzuki@med.showa-u.ac.jp.
Hiroshi
H
Suzuki
Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
Atsuo
A
Maeda
Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
Hideyuki
H
Maezawa
Department of Plastic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Tomoichiro
T
Togo
Department of Plastic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Hitoshi
H
Nemoto
Department of Plastic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Yoshiaki
Y
Kasai
Department of Plastic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Yoshinori
Y
Ito
Department of Dermatology, Showa University Fujigaoka Hospital, Yokohama, Japan.
Tokio
T
Nakada
Department of Dermatology, Showa University School of Medicine, Tokyo, Japan.
Hirohiko
H
Sueki
Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
Aya
A
Mizukami
Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
Mamiko
M
Takayasu
Division of Diabetes and Endocrinology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
Kenji
K
Iwaku
Department of Cardiovascular Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Susumu
S
Takeuchi
Department of Cardiovascular Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Hiroyuki
H
Tanaka
Department of Internal Medicine, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan.
Yoshitaka
Y
Iso
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016638:Critical Illness; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007511:Ischemia / Q000503:physiopathology*; D007564:Japan; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D015999:Multivariate Analysis; D010348:Patient Care Team / Q000458:organization & administration*; D058729:Peripheral Arterial Disease / Q000401:mortality* / Q000601:surgery*; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Critical limb ischemia; Multidisciplinary care; Peripheral artery disease