Nonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage.

Hdl Handle:
http://hdl.handle.net/10147/304783
Title:
Nonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage.
Authors:
Sultan, Sherif; Esan, Olubunmi; Fahy, Anne
Affiliation:
Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Galway, Ireland. sherifsultan@esatclear.ie
Citation:
Nonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage., 16 (3):130-9 Vascular
Publisher:
Vascular
Journal:
Vascular
Issue Date:
2008
URI:
http://hdl.handle.net/10147/304783
PubMed ID:
18674461
Abstract:
Critical limb ischemia (CLI) patients are at high risk of primary amputation. Using a sequential compression biomechanical device (SCBD) represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality. Thirty-five patients with 39 critically ischemic limbs (rest pain = 12, tissue loss = 27) presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment. The mean follow-up was 10 months (SD +/- 6 months). There were four amputations, with an 18-month cumulative limb salvage rate of 88% (standard error [SE] +/- 7.62%). Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mm Hg (SD +/- 33.7, 95% confidence interval [CI] 55-79). Popliteal artery flow velocity increased from 45 to 47.9 cm/s (95% CI 35.9-59.7). Cumulative survival at 12 months was 81.2% (SE +/- 11.1) for SCBD, compared with 69.2% in the control group (SE +/- 12.8%) (p = .4, hazards ratio = 0.58, 95% CI 0.15-2.32). The mean total cost of primary amputation per patient is euro29,815 ($44,000) in comparison with euro13,900 ($20,515) for SCBD patients. SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.
Item Type:
Article
Language:
en
MeSH:
Aged; Amputation; Arterial Occlusive Diseases; Blood Flow Velocity; Chemotherapy, Adjuvant; Epidemiologic Methods; Female; Health Care Costs; Hemodynamics; Humans; Intermittent Pneumatic Compression Devices; Ischemia; Limb Salvage; Lower Extremity; Male; Popliteal Artery; Toes; Treatment Outcome
ISSN:
1708-5381

Full metadata record

DC FieldValue Language
dc.contributor.authorSultan, Sherifen_GB
dc.contributor.authorEsan, Olubunmien_GB
dc.contributor.authorFahy, Anneen_GB
dc.date.accessioned2013-10-30T14:22:38Z-
dc.date.available2013-10-30T14:22:38Z-
dc.date.issued2008-
dc.identifier.citationNonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage., 16 (3):130-9 Vascularen_GB
dc.identifier.issn1708-5381-
dc.identifier.pmid18674461-
dc.identifier.urihttp://hdl.handle.net/10147/304783-
dc.description.abstractCritical limb ischemia (CLI) patients are at high risk of primary amputation. Using a sequential compression biomechanical device (SCBD) represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality. Thirty-five patients with 39 critically ischemic limbs (rest pain = 12, tissue loss = 27) presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment. The mean follow-up was 10 months (SD +/- 6 months). There were four amputations, with an 18-month cumulative limb salvage rate of 88% (standard error [SE] +/- 7.62%). Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mm Hg (SD +/- 33.7, 95% confidence interval [CI] 55-79). Popliteal artery flow velocity increased from 45 to 47.9 cm/s (95% CI 35.9-59.7). Cumulative survival at 12 months was 81.2% (SE +/- 11.1) for SCBD, compared with 69.2% in the control group (SE +/- 12.8%) (p = .4, hazards ratio = 0.58, 95% CI 0.15-2.32). The mean total cost of primary amputation per patient is euro29,815 ($44,000) in comparison with euro13,900 ($20,515) for SCBD patients. SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.en_GB
dc.language.isoenen
dc.publisherVascularen_GB
dc.rightsArchived with thanks to Vascularen_GB
dc.subject.meshAged-
dc.subject.meshAmputation-
dc.subject.meshArterial Occlusive Diseases-
dc.subject.meshBlood Flow Velocity-
dc.subject.meshChemotherapy, Adjuvant-
dc.subject.meshEpidemiologic Methods-
dc.subject.meshFemale-
dc.subject.meshHealth Care Costs-
dc.subject.meshHemodynamics-
dc.subject.meshHumans-
dc.subject.meshIntermittent Pneumatic Compression Devices-
dc.subject.meshIschemia-
dc.subject.meshLimb Salvage-
dc.subject.meshLower Extremity-
dc.subject.meshMale-
dc.subject.meshPopliteal Artery-
dc.subject.meshToes-
dc.subject.meshTreatment Outcome-
dc.titleNonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage.en_GB
dc.typeArticleen
dc.contributor.departmentDepartment of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Galway, Ireland. sherifsultan@esatclear.ieen_GB
dc.identifier.journalVascularen_GB
dc.description.fundingNo fundingen
dc.description.provinceConnachten
dc.description.peer-reviewpeer-reviewen
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