Abstract
Objective
To assess the outcome of conservative treatment of severe critical limb ischemia (CLI) classified as Rutherford 5/6.
Background
The preferred therapy for CLI is either endovascular revascularization or bypass surgery. With a growing aged population with more serious comorbidities, these therapies are not always a viable option. Primary amputation leads to decreased mobility and a reduced quality of life. There is a lack of literature regarding the outcome of conservative therapy.
Methods
Hospital charts were reviewed of all patients who were diagnosed with Rutherford classification 5–6 and received conservative treatment and lacked interventional options. Outcome measures were mortality, complete wound closure, and limb salvage rate.
Results
38 patients were included with a median age of 80 years (range 57–97). The amputation rate during follow-up was 16 %. In 58 % of patients, complete wound closure was achieved. All-cause mortality was 58 % with a 2-year survivability rate of 55 %.
Conclusions
Conservative management in our selected patients with CLI results in a moderate rate of wound closure and acceptable amputation rates albeit with a high mortality rate. For patients not eligible for endovascular revascularization or bypass surgery, conservative treatment could be a viable option besides primary limb amputation.
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Acknowledgments
We would like to thank our specialized wound care practitioners for their help with delivering the necessary data.
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Thomas, A.R., Raats, J.W., Lensvelt, M.M.A. et al. Conservative Treatment in Selected Patients with Severe Critical Limb Ischemia. World J Surg 39, 2090–2095 (2015). https://doi.org/10.1007/s00268-015-3069-6
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DOI: https://doi.org/10.1007/s00268-015-3069-6