Conservative Treatment in Selected Patients with Severe Critical Limb Ischemia

Thomas, A; Raats, Jelle W; Lensvelt, Mare M.A.; Groot, Hans G.W. de; Veen, Eelco J.; Laan, Lijckle van der

doi:10.1007/s00268-015-3069-6

Cited by 23 publications

(14 citation statements)

References 21 publications

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“…Patients with limb ischemia are a fragile and vulnerable group of patients 12 whose outcomes are negatively affected if the usual standard of care is delayed. It is therefore important that during a future pandemic, regular medical care should continue for these patients, with caregivers being aware of these patients and referring in time for revascularization.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Lockdown Strategy on Vascular Surgery Practice: More Major Amputations than Usual

Schuivens

Buijs

Winter

et al. 2020

Annals of Vascular Surgery

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Background: The aim of this study is to investigate the impact of the coronavirus disease 2019 (COVID-19) lockdown period on the number and type of vascular procedures performed in the operating theater. Methods: A total of 38 patients who underwent 46 vascular procedures during the lockdown period of March 16th until April 30th, 2020, were included. The control groups consisted of 29 patients in 2019 and 54 patients in 2018 who underwent 36 and 66 vascular procedures, respectively, in the same time period. Data were analyzed using SPSS Statistics. Results: Our study shows that the lockdown during the COVID-19 pandemic resulted in a significant increase in the number of major amputations (42% in 2020 vs. 18% and 15% in 2019 and 2020, respectively; P-value 0.019). Furthermore, we observed a statistically significant difference in the degree of tissue loss as categorized by the Rutherford classification (P-value 0.007). During the lockdown period, patients presented with more extensive ischemic damage when than previous years. We observed no difference in vascular surgical care for patients with an aortic aneurysm. Conclusions: Measurements taken during the lockdown period have a significant effect on noneCOVID-19 vascular patient care, which leads to an increased severe morbidity. In the future, policy makers should be aware of the impact of their measurements on vulnerable patient groups such as those with peripheral arterial occlusive disease. For these patients, medical care should be easily accessible and adequate.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Lockdown Strategy on Vascular Surgery Practice: More Major Amputations than Usual

Schuivens

Buijs

Winter

et al. 2020

Annals of Vascular Surgery

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“…Although many reports about revascularization for patients with CLI have been published, there are still few detailed reports about conservative treatments. [4][5][6][7][8][9][10][11] In this study, the systemic problems of patients who received conservative treatment were ischemic heart disease, respiratory occlusive disease, and a bedridden status. Low cardiac function and respiratory dysfunction were the main contraindications for surgery under general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…In previous reports, the follow-up period for conservatively treated patients with CLI was one or two years. 4,10) Thomas, et al reported that the median time to mortality was seven months, and the two-year survival rate was 55% in patients with CLI who underwent conserva-tive treatment. 10) Gu, et al reported the one-year outcomes of 30 patients with CLI who received conservative treatment, including two patients with revascularization failure.…”

Section: Discussionmentioning

confidence: 99%

“…4,10) Thomas, et al reported that the median time to mortality was seven months, and the two-year survival rate was 55% in patients with CLI who underwent conserva-tive treatment. 10) Gu, et al reported the one-year outcomes of 30 patients with CLI who received conservative treatment, including two patients with revascularization failure. 11) Five patients (17%) died and 11 patients (37%) un-derwent above-knee or below-knee amputations.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…Patients with CLI have cardiovascular event rates higher than those in patients with symptomatic coronary artery disease 4. Thomas et al found that in patients with conservatively treated severe CLI, all-cause mortality was 58% with a 2-year survivability rate of 55% 5. The 5-year mortality exceeds that of colorectal cancer, breast cancer, stroke, acute myocardial infarction and prostate cancer 6…”

Section: Introductionmentioning

confidence: 99%

Systematic review of pharmacological therapies for the management of ischaemic pain in patients with non-reconstructable critical limb ischaemia

Laoire¹,

Murtagh

2017

BMJ Support Palliat Care

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BackgroundCritical limb ischaemia (CLI) is a severe manifestation of peripheral arterial disease, characterised by chronic ischaemic rest pain, ulcers or gangrene. Management of ischaemic pain is challenging in patients with no options for revascularisation and optimal pharmacological therapies have not been established.ObjectivesTo identify and evaluate the effectiveness of pharmacological therapies to treat ischaemic pain secondary to non-reconstructable CLI.MethodsThis systematic review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Comprehensive searches of three electronic databases, a PubMed-related articles link search, grey literature search and hand-searches of the bibliographies of relevant papers and textbooks were performed. Studies recruiting adult patients with CLI of any aetiology were eligible for inclusion. Surgical and revascularisation procedures, and all invasive interventions were excluded.ResultsOf 792 studies, six met full inclusion criteria. These studies researched the use of intravenous lidocaine, intravenous ketamine, oral gabapentin and the combination of transdermal buprenorphine and epidural morphine/ropivacaine infusion. All studies showed an improvement in severity of ischaemic pain in CLI but with varying side effect profiles and quality. The extracted studies showed substantial heterogeneity and therefore a meta-analysis was not performed.ConclusionThe pharmacological management of pain secondary to non-reconstructable CLI is a challenging review topic. No recommendations of pharmacological agents can be made following this review but a number of novel approaches to manage pain in this cohort have shown positive results and require further investigation.

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Conservative Treatment in Selected Patients with Severe Critical Limb Ischemia

Cited by 23 publications

References 21 publications

Impact of the COVID-19 Lockdown Strategy on Vascular Surgery Practice: More Major Amputations than Usual

Impact of the COVID-19 Lockdown Strategy on Vascular Surgery Practice: More Major Amputations than Usual

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

Systematic review of pharmacological therapies for the management of ischaemic pain in patients with non-reconstructable critical limb ischaemia

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