CHANGES IN THE MANAGEMENT OF CRITICAL LIMB ISCHEMIA

A prospective study of all patients with critical limb ischaemia (CLI) who presented to a single vascular unit was undertaken for a 12-month period. There were 222 referrals in 188 patients, 80.2 per cent of wh ich were emergency or urgent admissions. The majority (72.5 per cent) were initially investigated with colour duplex scanning to characteriz e the arterial lesion. Diagnostic angiography was performed in 35.1 pe r cent. An attempt at revascularization was made in 73.0 per cent of c ases using percutaneous transluminal angioplasty (PTA) in 42.3 per cen t, surgery in 24.3 per cent, and a combination of surgery and PTA in 6 .3 per cent. Primary major amputation was required in 22 cases (9.9 pe r cent) and conservative treatments were used in 38 (17.1 per cent). T he in-hospital mortality rate was 10 per cent with a limb salvage rate of 79 per cent. Diabetes was an independent risk factor for amputatio n (odds ratio 2.4, 95 per cent confidence interval 1.22-4.79, P=0.012) . Median hospital stay was much shorter for patients treated by PTA (4 .5 days) than surgery (16 days) or primary amputation (18 days). The c omplication rate of PTA requiring surgery was 5.5 per cent. CLI repres ents a large non-elective workload for a vascular unit. The increasing use of noninvasive duplex assessment and angioplasty plays a major pa rt in the successful management of these patients.