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Nonoperative Active Management of Critical Limb Ischemia: Initial Experience Using a Sequential Compression Biomechanical Device for Limb Salvage
Sherif Sultan; Olubunmi Esan; Anne Fahy
Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Galway, Ireland
Vascular 2008;16(3):130-139
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 mmHg (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 €29,815 ($44,000) in comparison with €13,9000 ($20,515) for SCBD patients.
SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.
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