Nonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage.
Affiliation
Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Galway, Ireland. sherifsultan@esatclear.ieIssue Date
2008MeSH
AgedAmputation
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
Metadata
Show full item recordCitation
Nonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage., 16 (3):130-9 VascularPublisher
VascularJournal
VascularPubMed ID
18674461Abstract
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
ArticleLanguage
enISSN
1708-5381Collections
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