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Patients with Critical Limb Ischemia in the Outpatient Setting

Authors

Aleksandra Kolarczyk-Haczyk, MD, Wojciech Trendel, MD, Aleksandra Blachut, MD, Maciej Pruski, Jr., MD, American Heart of Poland, Silesia, Poland; Radoslaw Stefan Kiesz, MD, San Antonio Endovascular and Heart Institute, San Antonio, Texas

Abstract Number
7

Introduction: Critical limb ischemia (CLI) is a significant morbid disease defined as a severe manifestation of peripheral arterial disease (PAD) and occurs in a chronic setting with the presence of claudication symptoms over a long period. 

Objectives: The aim was to compare patients with and without CLI in baseline and long-term observation to indicate which factors should be paid particular attention. 

Methods: This is a retrospective, single-center, outpatient center registry of 96 consecutive patients with PAD, in whom endovascular procedures utilizing stents or angioplasty were performed from January 2015 to September 2016. Patients were divided into two groups: those with CLI (“CLI 1”) (n = 46) and those without (“CLI 0”) (n = 50). We compared baseline characteristics and performed long-term observation analysis. Endpoint was the composite of death, myocardial infarction (MI), stroke, target-vessel reintervention (TVR) and target-lesion reintervention (TLR), and amputation at 30 days, and 3, 6, 9, 12, and 24 months. 

Results: There were no significant differences in basic demographic and clinical characteristics between groups except higher occurrence of diabetes (72% vs 52%; P<.05), end-stage renal disease (30% vs 8%; P<.05), and presence of ulceration (30% vs 2%; P<.05) in the CLI 1 group. There was significant difference in exercising (50% vs 20%; P<.05) in the CLI 0 group. There were no differences between cardio and cerebrovascular events at 30 days from discharge. At long-term observation, there were no significant differences between groups in regard to mortality, MI, and stroke incidence. The risk of TVR (6% vs 41%; P<.05), TLR (6% vs 37%; P<.05), and amputation (0% vs 9%; P<.05) was significantly lower in the CLI 0 group when compared with the CLI 1 group. 

Conclusions: CLI occurs more often in patients with end-stage renal disease, in those on dialysis, and in patients with diabetes. Long-term observation demonstrated patients with CLI have more frequent and repeated endovascular procedures and amputations.

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