A PROSPECTIVE EPIDEMIOLOGIC SURVEY OF THE NATURAL-HISTORY OF CHRONIC CRITICAL LEG ISCHEMIA

Objective: To draw a picture of the different practices adopted for th e diagnosis, specific treatment and general care of critical leg ischa emia (CLI) in the light of the recommendations of the recent Consensus Document. Design: Prospective observational study. Setting: A represe ntative sample of vascular and general surgery, angiology, general med icine departments of the Italian National Health Service. Subjects: Pa tients with leg ischaemia considered as chronic and critical according to the definition and diagnostic criteria adopted in each centre. Chi ef outcome measures: Epidemiological profile of the standard populatio n; prevalence of definition criteria and of diagnostic and therapeutic procedures; short and medium-term clinical outcome as well as of the general vascular morbidity and mortality. Main results: Over a 3 month period, 574 patients were recruited in 69 centres mainly on the basis of clinical findings of CLI (rest pain and/or trophic lesions). They had an adequate diagnostic assessment of their vascular lesions and a high cardiovascular risk in terms of prior morbidity and presence of r isk factors, Over half of the patients underwent revascularisation and three quarters were given pharmacological treatments. At the end of t he observation period, 50 patients had died (8.7%), three had had a my ocardial infarction (0.5%), six a stroke (1.0%), 70 a major amputation (12.2%) and 103 had persistent CLI (17.9%). Conclusions: This survey confirms the dramatic prognosis of patients with CLI and provides an a ppropriate background and setting to conduct experimental clinical stu dies in this field.