Sequential compression biomechanical device versus primary amputation in patients with critical limb ischemia.

Hdl Handle:
http://hdl.handle.net/10147/304742
Title:
Sequential compression biomechanical device versus primary amputation in patients with critical limb ischemia.
Authors:
Tawfick, Wael A; Hamada, Nader; Soylu, Esraa; Fahy, Anne; Hynes, Niamh; Sultan, Sherif
Affiliation:
1Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital, Galway (UCHG), Galway, Ireland.
Citation:
Sequential compression biomechanical device versus primary amputation in patients with critical limb ischemia. 2013, 47 (7):532-9 Vasc Endovascular Surg
Publisher:
Vascular and endovascular surgery
Journal:
Vascular and endovascular surgery
Issue Date:
Oct-2013
URI:
http://hdl.handle.net/10147/304742
DOI:
10.1177/1538574413499413
PubMed ID:
24052447
Abstract:
Introduction: Patients with critical limb ischemia (CLI), who are unsuitable for intervention, face the consequence of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients. Objectives: To assess the outcome of SCBD in patients with severe CLI who are unsuitable for revascularization. Primary end points were limb salvage and 30-day mortality. Methods: From 2005 to 2012, 189 patients with severe CLI were not suitable for revascularization. In all, 171 joined the SCBD program. We match controlled 75 primary amputations. Results: All patients were Rutherford category 4 or higher. Sustained clinical improvement was 68% at 1 year. Mean toe pressure increased from 19.9 to 35.42 mm Hg, P < .0001. Mean popliteal flow increased from 35.44 to 55.91 cm/sec, P < .0001. The 30-day mortality was 0.6%. Limb salvage was 94% at 5 years. Freedom from major adverse clinical events was 62.5%. All-cause survival was 69%. Median cost of managing a primary amputation patient is €29 815 compared to €3985 for SCBD. We treated 171 patients with artassist at a cost of €681 965. However, primary amputation for 75 patients cost €2 236 125. Conclusion: The SCBD therapy is a cost-effective and clinically effective solution in patients with CLI having no option of revascularization. It provides adequate limb salvage while providing relief of rest pain without any intervention.
Item Type:
Article
Language:
en
Local subject classification:
VASCULAR DISEASE
ISSN:
1938-9116

Full metadata record

DC FieldValue Language
dc.contributor.authorTawfick, Wael Aen_GB
dc.contributor.authorHamada, Naderen_GB
dc.contributor.authorSoylu, Esraaen_GB
dc.contributor.authorFahy, Anneen_GB
dc.contributor.authorHynes, Niamhen_GB
dc.contributor.authorSultan, Sherifen_GB
dc.date.accessioned2013-10-30T11:46:17Z-
dc.date.available2013-10-30T11:46:17Z-
dc.date.issued2013-10-
dc.identifier.citationSequential compression biomechanical device versus primary amputation in patients with critical limb ischemia. 2013, 47 (7):532-9 Vasc Endovascular Surgen_GB
dc.identifier.issn1938-9116-
dc.identifier.pmid24052447-
dc.identifier.doi10.1177/1538574413499413-
dc.identifier.urihttp://hdl.handle.net/10147/304742-
dc.description.abstractIntroduction: Patients with critical limb ischemia (CLI), who are unsuitable for intervention, face the consequence of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients. Objectives: To assess the outcome of SCBD in patients with severe CLI who are unsuitable for revascularization. Primary end points were limb salvage and 30-day mortality. Methods: From 2005 to 2012, 189 patients with severe CLI were not suitable for revascularization. In all, 171 joined the SCBD program. We match controlled 75 primary amputations. Results: All patients were Rutherford category 4 or higher. Sustained clinical improvement was 68% at 1 year. Mean toe pressure increased from 19.9 to 35.42 mm Hg, P < .0001. Mean popliteal flow increased from 35.44 to 55.91 cm/sec, P < .0001. The 30-day mortality was 0.6%. Limb salvage was 94% at 5 years. Freedom from major adverse clinical events was 62.5%. All-cause survival was 69%. Median cost of managing a primary amputation patient is €29 815 compared to €3985 for SCBD. We treated 171 patients with artassist at a cost of €681 965. However, primary amputation for 75 patients cost €2 236 125. Conclusion: The SCBD therapy is a cost-effective and clinically effective solution in patients with CLI having no option of revascularization. It provides adequate limb salvage while providing relief of rest pain without any intervention.en_GB
dc.language.isoenen
dc.publisherVascular and endovascular surgeryen_GB
dc.rightsArchived with thanks to Vascular and endovascular surgeryen_GB
dc.subject.otherVASCULAR DISEASEen_GB
dc.titleSequential compression biomechanical device versus primary amputation in patients with critical limb ischemia.en_GB
dc.typeArticleen
dc.contributor.department1Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital, Galway (UCHG), Galway, Ireland.en_GB
dc.identifier.journalVascular and endovascular surgeryen_GB
dc.description.fundingNo fundingen
dc.description.provinceConnachten
dc.description.peer-reviewpeer-reviewen
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