Skip to main content

Advertisement

SpringerLink
Log in

The efficacy of a multidisciplinary team approach in critical limb ischemia

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

The aim of the present study was to clarify the characteristics of Japanese critical limb ischemia (CLI) patients and analyze the rates of real-world mortality and amputation-free survival (AFS) in all patients with Fontaine stage IV CLI who were treated with/without revascularization therapy by an intra-hospital multidisciplinary care team. All consecutive patients who presented with CLI at Showa University Fujigaoka Hospital between April 2008 and March 2014 were prospectively registered. The intra-hospital committee consisted of cardiologists, plastic surgeons, dermatologists, diabetologists, nephrologists, cardiovascular surgeons, and vascular technologists. The primary endpoint of this study was all-cause mortality and AFS during the follow-up period. The present study included 145 patients with Fontaine stage IV CLI. The mean age was 76.5 ± 10.2 years. The all-cause mortality rate during the follow-up period (15.5 ± 16.1 months) was 21.4 %. The AFS rate during the follow-up period (14.1 ± 16.4 months) was 58.6 %. A multivariate Cox proportional hazards regression analysis found that age >75 years and hemodialysis were significantly associated with all-cause mortality; and that age >75 years, Rutherford 6, and wound infection were significantly associated with AFS. A multidisciplinary approach and comprehensive care may improve the outcomes and optimize the collaborative treatment of CLI patients. However, all-cause mortality remained high in patients with Fontaine stage IV CLI and early referral to a hospital that can provide specialized treatment for CLI, before the occurrence of major tissue loss or infection, is necessary to avoid primary amputation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, On behalf of the TASC II Working Group (2007) Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 45(1 Suppl):S5–S67

    Article  PubMed  Google Scholar 

  2. Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas JL, Goto S, Liau CS, Richard AJ, Rother J, Wilson PWF, For the REACH Registry Investigators (2006) International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 295:180–189

    Article  CAS  PubMed  Google Scholar 

  3. Yamazaki T, Goto S, Shigematsu H, Shimada K, Uchiyama S, Nagai R, Yamada N, Matsumoto M, Origasa H, Bhatt DL, Steg PG, Ikeda Y, for the REACH Registry Investigators (2007) Prevalence, awareness and treatment of cardiovascular risk factors in patients at high risk of atherothrombosis in Japan. Circ J 71:995–1003

    Article  PubMed  Google Scholar 

  4. Kumagai M, Marui A, Tabata Y, Takeda T, Yamamoto M, Yonezawa A, Tanaka S, Yanagi S, Ito-Ihara T, Ikeda T, Murayama T, Teramukai S, Katsura T, Matsubara K, Kawakami K, Yokode M, Shimizu A, Sakata R (2015) Safety and efficacy of sustained release of basic fibroblast growth factor using gelatin hydrogel in patients with critical limb ischemia. Hear Vessels. doi:10.1007/s00380-015-0677-x

    Google Scholar 

  5. Takahara M, Kaneto H, Katakami N, Iida O, Matsuoka M, Shimomura I (2014) Effect of sarpogrelate treatment on the prognosis after endovascular therapy for critical limb ischemia. Heart Vessels 29:563–567

    Article  PubMed  Google Scholar 

  6. Conte MS, Geraghty PJ, Bradbury AW, Hevelone ND, Lipsitz SR, Moneta GL, Nehler MR, Powell RJ, Sidawy AN (2009) Suggested objective performance goals and clinical trial design for evaluating catheter-based treatment of critical limb ischemia. J Vasc Surg 50:1462–1473

    Article  PubMed  Google Scholar 

  7. Iida O, Nakamura M, Yamauchi Y, Kawasaki D, Yokoi Y, Yokoi H, Soga Y, Zen K, Hirano K, Suematsu N, Inoue N, Suzuki K, Shintami Y, Miyashita Y, Urasawa K, Kitano I, Yamaoka T, Murakami T, Uesugi M, Tsuchiya T, Shinke T, Oba Y, Ohara N, Hamasaki T, Nanto S (2013) Endovascular treatment for infrainguinal vessels in patients with critical limb ischemia: OLIVE registry, a prospective, multicenter study in Japan with 12-month follow-up. Circ Cardiovasc Interv 6:68–76

    Article  PubMed  Google Scholar 

  8. Sumpio BE, Armstrong DG, Lavery LA, Andros G, SVS/APMA writing group (2010) The role of interdisciplinary team approach in the management of the diabetic foot: a joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association. J Vasc Surg 51(6):1504–1506

    Article  PubMed  Google Scholar 

  9. Horie T, Onodera R, Akamatsu M, Ichikawa Y, Hoshino J, Kaneko E, Iwashitah C, Ishidai A, Tsukamotoj T, Teramukai S, Fukushima M, Kawamura A, For Japan Study Group of Peripheral Vascular Regeneration Cell Therapy (JPRCT) (2010) Long-term clinical outcomes for patients with lower limb ischemia implanted with G-CSF-mobilized autologous peripheral blood mononuclear cells. Atherosclerosis 208:461–466

    Article  CAS  PubMed  Google Scholar 

  10. Wolfe JHN, Wyatt MG (1997) Critical and subcritical ischaemia. Eur J Vasc Endovasc Surg 13:578–582

    Article  CAS  PubMed  Google Scholar 

  11. Conrad MF, Crawford RS, Hackney LA, Paruchuri VP, Abularrage CJ, Patel VI, Lamuraglia GM, Cambria RP (2011) Endovascular management of patients with critical limb ischemia. J Vasc Surg 53:1020–1025

    Article  PubMed  Google Scholar 

  12. Miyahara T, Suhara M, Nemoto Y, Shirasu T, Haga M, Mochizuki Y, Matsukura M, Arai T, Taniguchi R, Nemoto M, Yamamoto S, Nishiyama A, Hosaka A, Hoshina K, Okamoto H, Shigematsu K, Miyata T, Watanabe T (2015) Long-term results of treatment for critical limb ischemia. Ann Vasc Dis 8:192–197

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chung J, Modrall G, Ahn C, Lavery LA, Valentine RJ (2015) Multidisciplinary care improves amputation-free survival in patients with chronic critical limb ischemia. J Vasc Surg 61:162–169

    Article  PubMed  Google Scholar 

  14. Zayed H, Halawa M, Maillardet L, Sidhu S, Edmonds M, Rashid H (2008) Improving limb salvage rate in diabetic patients with critical leg ischaemia using a multidisciplinary approach. Int J Clin Pract 63:855–858

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Yuki Henmi, Tomoko Sasai, Mamoru Hatakeyama, Mie Hashimoto, and Akira Kaminomiya in the physiological laboratory in Showa University Fujigaoka Hospital for their technological assistance, and DRs. Kenta Miyabe, Seiko Nakae, Yuka Suzuki, Taisuke Kamiyama, Chie Sugisawa in Showa University Fujigaoka Hospital for their help for this study.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan

    Hiroshi Suzuki, Atsuo Maeda & Hideyuki Maezawa

  2. Department of Plastic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan

    Tomoichiro Togo, Hitoshi Nemoto, Yoshiaki Kasai & Yoshinori Ito

  3. Department of Dermatology, Showa University Fujigaoka Hospital, Yokohama, Japan

    Tokio Nakada

  4. Department of Dermatology, Showa University School of Medicine, Tokyo, Japan

    Hirohiko Sueki

  5. Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan

    Aya Mizukami & Mamiko Takayasu

  6. Division of Diabetes and Endocrinology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan

    Kenji Iwaku

  7. Department of Cardiovascular Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan

    Susumu Takeuchi & Hiroyuki Tanaka

  8. Department of Internal Medicine, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan

    Yoshitaka Iso

Authors
  1. Hiroshi Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atsuo Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hideyuki Maezawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomoichiro Togo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hitoshi Nemoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshiaki Kasai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoshinori Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tokio Nakada
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hirohiko Sueki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Aya Mizukami
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mamiko Takayasu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kenji Iwaku
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Susumu Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hiroyuki Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yoshitaka Iso
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroshi Suzuki.

Ethics declarations

Conflict of interest

The authors do not have any disclosures regarding financial relationships with a biotechnology manufacturer, a pharmaceutical company, or other commercial entity that has an interest in the subject matter or materials discussed in the manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Suzuki, H., Maeda, A., Maezawa, H. et al. The efficacy of a multidisciplinary team approach in critical limb ischemia. Heart Vessels 32, 55–60 (2017). https://doi.org/10.1007/s00380-016-0840-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-016-0840-z

Keywords

Search

Navigation