Seminars in vascular surgery
-
Review Comparative Study
The fate of patients with critical leg ischemia.
In some highly specialized and aggressive units, 90% of patients with critical leg ischemia (CLI) will undergo some form of surgical or endovascular procedure; however, in most, the figure is nearer 50 to 60%. The primary amputation rate varies from around 10% to 40%. The mortality rate in these patients with standard therapy is around 20% at 1 year and between 40% and 70% at 5 years. ⋯ There appears to be a decline in overall major amputation rates associated with a corresponding increase in revascularizations. However, although technical advances may have resulted in a steadying or even decrease in amputations, comparisons of total amputations over a longer period suggest an increase, presumably attributable to an aging population. Some forward projections predict that major amputations will be doubled in the next 30 years.
-
The major amputation rate is approximately 200 to 500/million/yr and occurs in patients presenting with an acute onset of critical leg ischemia (CLI) rather than in patients who steadily progress through increasingly severe claudication to rest pain and ulcers. Diabetics, who form only 2% to 5% of the population, form 40% to 45% of all amputees. Although it is widely believed that a below-knee (BK) to above-knee (AK) amputation ratio of 2.5 is the minimum acceptable for units providing a lower limb amputation service, the ratio is in fact usually very much below the recommended figure. ⋯ A total of 90% of AK major amputations heal, 70% primarily. Two to three times as many BK amputees achieve full mobility than AK amputees, and there has not been any dramatic change in 20 years. The fate of the amputee 2 years after a successful BK amputation will be that 15% will have been converted to an AK amputation, another 15% will have had a contralateral major amputation, and 30% will be dead.