Outcomes in Patients with Critical Limb Ischemia due to Arteriosclerosis Obliterans Who Did Not Undergo Arterial Reconstruction

Abstract

The prevalence of arteriosclerosis obliterans (ASO) and critical limb ischemia (CLI) is currently increasing, and arterial reconstruction is often attempted to salvage the limb. Some patients cannot undergo attempted revascularization because of contraindications, and they only receive conservative treatment. In this study, we investigate the comorbidities and survival rates of patients with CLI who receive conservative treatment. Thirty-five patients with CLI due to ASO, who had not undergone revascularization surgery (C group), were enrolled. As controls, 136 patients with CLI due to ASO who did undergo revascularization (R group), mainly via bypass surgery, were enrolled. Coronary artery disease, heart failure, and respiratory dysfunction were factors indicating conservative treatment. Limb salvage rates and survival rates were not significantly different between the two groups. Patients who had survived for less than two years after surgery had a higher prevalence of chronic heart failure, cardiovascular disease, and end-stage renal disease compared to patients who had survived for more than two years. The use of statins, dual antiplatelets, aspirin, or warfarin did not influence whether a patient survived for longer than two years. 77% of patients survived for more than two years after receiving only conservative therapies. Surgical revascularization did not improve the prognosis of patients with CLI as compared with the conservative therapy. Clinicians might start with conservative treatment while considering other treatment options for patients with CLI.

Telomerase Plays a Pivotal Role in Collateral Growth Under Ischemia by Suppressing Age-Induced Oxidative Stress, Expression of p53, and Pro-Apoptotic Proteins

“…It has been proposed that the enzymatic activity of telomerase is primarily controlled by transcriptional regulation of TERT, as shown in our results at POD 3. In contrast, there are many reports that telomerase activity is regulated by several factors, such as ROS, exercise capacity and cellular stress related to the magnitude of ischemia, 32,40,41) which may affect TERT expression and telomerase activity in chronic ischemic conditions. We did not observe a positive correlation between telomerase activity and TERT expression in ischemic old mice at POD 21.…”

“…Critical limb ischemia is an end-stage of PAD and is associated with a high risk of lower limb loss. 32) Therefore, new treatments that rescue the ischemic limb for patients of PAD are necessary. Telomerase is closely related with cellular senescence and may be a potential anti-aging therapy.…”

Multidisciplinary Treatment for Critical Limb Ischemia in Peripheral Arterial Disease

“…However, there are some cases of CLI that exist but do not advance despite not receiving any treatment. 3) Conversely, some wounds end up being subjected to lower limb amputation even when the degree of ischemia is mild. Thus, the appropriateness of making decisions on therapeutic strategies that are solely based on the degree of ischemia is now being questioned.…”

Ameliorative effects of the traditional Chinese medicine formula Qing-Mai-Yin on arteriosclerosis obliterans in a rabbit model

“… 2010 ; Akagi et al. 2018 ; Halliday and Bax 2018 ). Epidemiological surveys have reported that currently approximately 200,000,000 patients are suffering from ASO worldwide (Halliday and Bax 2018 ; Zhang R et al.…”