Critical Limb Ischemia: Revascularization Options and Clinical Outcome

Hussein A Heis, Nawaf J Shatanawi, Kamal E Bani-Hani, Mwaffaq A Elheis, Hassan A Balas, Hazem k Habboub

Abstract


Objectives: To study the various options of revascularization, mainly the role of Percutaneous Transluminal Angioplasty (PTA) in the treatment of Critical Limb Ischemia (CLI) and to assess the clinical outcome.

Material and Methods: A retrospective study was performed involving 109 consecutive patients (75 men and 34 women; mean age 59 years, range 45-87). Fifty-nine patients were diabetic, and sixty-four smokers. Balloon angioplasty for critical limb ischemia was performed in 78 limbs, while Percutaneous Transluminal Angioplasty (PTA) and/or surgery in 34 limbs. Immediate and at one year outcome was examined by case note review to determine survival, amputation-free survival, and limb salvage.

Results: In the angioplasty, technical success was achieved in 66 (84%) out of 78 limbs, while in the combined PTA and/or surgery it was 22 limbs (65%) out of 34 limbs. The overall amputation rate was 22%. The follow-up period was 12 months. The overall in-hospital mortality was five patients (4.6%). Eighty patients (74%) had their feet spared from major amputation as a result of revascularization. Only sixty-tow patients were available for follow-up which revealed that 84% of them were doing well 12 months after their revascularizations. Patients with an initially successful angioplasty had a good outcome.

Conclusions: The results of this study justify the use of PTA as a first-line treatment for critical limb ischemia; technical failure does not preclude conventional surgery. CLI is highly prevalent among diabetes. CLI was significantly associated with diabetes, smoking, and gangrene. Educational programs and aggressive approach are highly needed to reduce the risk of amputations

Keywords


: Critical, Ischemia, Limb, angioplasty, salvage.

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