CRITICAL LIMB ISCHEMIA - MANAGEMENT AND OUTCOME - REPORT OF A NATIONAL SURVEY

Aim: A prospective national survey of patients with critical lower lim b ischaemia was carried out to estimate the prevalence of critical low er limb ischaemia in Britain and Ireland; and to assess the average na tional outcome following treatment. Method: The surgeons were selected randomly but stratified according to the number of vascular surgical operations performed annually to match the profile of the vascular sur gical population of the country as a whole. Outcome measures: The main outcome measures were the primary treatment intention; final treatmen t undertaken; duration of hospital stay final outcome in terms of mort ality and limb salvage rates and destination on discharge. Results: Th e data reveal that the extrapolated incidence of critical lower limb i schaemia in Great Britain and Ireland was 21 450 limbs in 20 000 patie nts, equating to a prevalence of 1 in 2500 of the population annually. Thirty per cent of the patients were diabetic. The overall mortality and amputation rates were 13.5% and 21.5% respectively The mean durati on of hospital stay was 25 days. Nearly 70% of patients were offered s ome form of revascularisation as the primary treatment option with a 7 5% chance of successful limb salvage. Amputation was associated with a significantly higher mortality (Chi square = 10.79, p = 0.001), longe r hospital stay (t = 4.589, p < 0.0001) and a greater proportion of pa tients requiring long-term institutional support, than revascularisati on. The ratio of revascularisation to amputation was 4:1. Surgeons wit h a lower annual experience of patients with vascular disease fended t o undertake fewer revascularisations (Chi square = 6.737,p = 0.0094) a nd more amputations (Chi square = 10.445, p= 0.0012) than those treati ng larger numbers. The mean limb salvage rate achieved by surgeons wit h a lower throughput of vascular operations was significantly lower th at achieved by other groups of surgeons (Chi square = 7.544,p = 0.0045 ).