Abstract
A very small proportion (1%) of patients with peripheral artery disease (PAD) present with critical limb threatening ischaemia (CLTI) with poor prognosis. The present review showcased several pre-operative predictors and key post-operative outcomes. Identification of any modifiable predictors may impact positively on surgical outcomes. PubMed/Medline, Google scholar and Cochrane databases were searched using terms such as "peripheral arterial disease" AND "critical limb ischemia," "post-operative outcome," AND "predictors of post-operative outcomes". Search was for relevant English-language articles published between January 1997 and December 2007 Selected articles were screened first by title and abstract, and selection of full articles was based on relevance using our inclusion and exclusion criteria and quality ratings performed with the MINORS score. The included studies were published between 1997 and 2007. Only six (6) articles out of a total of 2,114 were deemed suitable for analysis. Ambulatory recovery was >70% at six months, 86.7% and 70.0% at one year and five years respectively. Rate of local wound complications was between 12% and 24%. Reported limb salvage rates were >90% at six months, >70% at one year and 70.0-90.0% at five years. Primary graft patency rate at one year ranged from 63% and 76.6%. Gangrene, diabetes and impaired pre-operative ambulatory function are associated with more wound complications, low limb salvage, reduced graft patency and poor functional outcome. Pre-operative ambulatory status was the most important predictor of post-operative ambulatory recovery. Diabetes mellitus was an important risk factor for prolonged wound healing, local wound complications and major amputation. None declared.
Highlights
Assessment of post-operative outcomes of vascular intervention for critical limb threatening ischaemia (CLTI) is increasingly shifting from traditional technical outcomes such as graft patency and limb-salvage,[1] to functional outcomes such as ambulatory recovery and wound healing rates.[2,3,4,5,6] Functional outcomes have been shown in recent reports to be better outcome measures to assess clinical success of operative interventions for CLTI
Assessment of post-operative outcomes of vascular intervention for CLTI is increasingly shifting from traditional technical outcomes such as graft patency and limb-salvage,[1] to functional outcomes such as ambulatory recovery and wound healing rates.[2,3,4,5,6]
Despite > 70% limb salvage and graft patency at three years, only 44.4% of the patients achieved the composite endpoint of clinical success as stated above.[3]
Summary
Assessment of post-operative outcomes of vascular intervention for CLTI is increasingly shifting from traditional technical outcomes such as graft patency and limb-salvage,[1] to functional outcomes such as ambulatory recovery and wound healing rates.[2,3,4,5,6] Functional outcomes have been shown in recent reports to be better outcome measures to assess clinical success of operative interventions for CLTI. Despite > 70% limb salvage and graft patency at three years, only 44.4% of the patients achieved the composite endpoint of clinical success as stated above.[3] Goshima et al showed that time to heal exceeded three months in >50% of patients and that diabetes mellitus was a risk factor for prolong wound healing.[2] Taylor et al have suggested that a combination of traditional and functional outcomes is superior in the assessment of post-operative outcome post-intervention for CLTI.[3]
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