Impact of different therapeutic alternatives in treatment of severe limb ischemia: Experiences on 190 consecutive patients at a department of medicalangiology
Me. Gschwandtner et al., Impact of different therapeutic alternatives in treatment of severe limb ischemia: Experiences on 190 consecutive patients at a department of medicalangiology, VASA, 28(4), 1999, pp. 271-278
Background: Different therapies in consecutive patients (1987-1992) with ch
ronic critical limb ischemia at a department of medical angiology, their sh
ort- and long-term outcome were investigated.
Patients and methods: 190 patients (112 males, 78 females; age: 67 +/- 12 y
ears); 78 in grade II, 112 in grade III according to Rutherford's classific
ation. Therapeutic regimen: 1. vascular recanalisation by percutaneous tran
sluminal angioplasty [PTA], local or systemic lysis; 2. surgical vascular r
econstruction in case of impossibility, or failure of catheter procedures;
3. prostanoids and/or antibiotics; 4. local wound treatment including amput
ations.
Results: Vascular recanalisation was attempted in 156/190 (82.1%): PTA in 1
16/190 surgical vascular reconstruction in 50/190, local in 24/190 and syst
emic lysis in 8/190 patients. Prostanoids were applied in 89/190 and antibi
otics in 73/190 patients.
At the time of dismissal 164/190 (86.3%) patients were clinically improved;
11/190 (5.8%) unchanged, 13/190 (6.8%) had undergone major amputations and
2/190 (1.1%) had died. After 2, 6 +/- 2,2 years 77 of the 141 patients, wh
o were still alive, were reexamined Among these 77 patients 84.4% were in g
rade 0 or I, 15.6% in chronic critical limb ischemia. Furthermore 13.0% had
been amputated since dismissal. Forty-nine of 190 (25.8%) patients had die
d 3,2 +/- 1,9 years after dismissal from hospital.
Conclusion: Catheter techniques, mostly PTA, is possible in the majority of
patients with chronic critical limb ischemia. Cooperation with vascular su
rgeons in case of technical impossibility or failure of catheter recanalisa
tion is mandatory. Such a regimen yields satisfactory short- and long-term
results and a low rate of complications.