English

Abstract

OBJECTIVE: To study the trends in revascularization procedures done for critical limb ischemia (CLI) of lower limbs. MATERIALS AND METHODS: Total of 166 revascularization procedures done for CLI by a single vascular surgeon between June 2010 and May 2014 at Kempegowda Institute of Medical Sciences Bangalore. Both endovascular and open bypass procedures for lower limb ischemia were included. This retrospective study was conducted to evaluate the outcomes of the procedures and to see the trends in the management of CLI of lower limb. Only elective cases were included in the study. Emergency revascularization procedures for acute limb ischemia and those below 45 years suspected to be thromboangiitis obliterans were excluded STUDY PERIOD: Review of 4 year experience from June 2010 to May 2014. Follow up period was 24 months. Patients were predominantly male (94%), of the 5th and 7th decade of life (Median age 60 years).All patients presented with chronic lower limb ischemia with critical limb ischemia. Commonest presentation was disabling claudication, rest pain with ulcerations and digital gangrene. Co morbid conditions included diabetes mellitus, smoking history, hypertension, hyperlipidemia, cardiac disease. Total procedures done: Open- 104, Endovascular- 62. Open procedures: Aorto-femoral (21) femoro-femoral (33) femoropopliteal (50). Primary endovascular revascularization procedures angioplasty alone (53 %) angioplasty + stenting (47 %). Complication rate was significantly higher and the mean hospital stay was significantly longer with open surgery (15%, 10 days) compared with endovascular surgery (0.08%, 4days) (P < 0.05). Furthermore the number of endovascular revascularization procedures done significantly increased from6% in the first period (June 2010-May 2011) to 61% in the last period (June2013-May2014). CONCLUSIONS: Endovascular procedures for CLI have largely replaced open surgical procedures. Angioplasty is a feasible, safe, and effective procedure with less morbidity and can be the procedure of choice for the primary and secondary treatment of CLI. Open bypass surgery can be reserved for lesions technically unsuitable for endovascular procedures and patients who do not demonstrate clinical improvement after angioplasty.