Natural history of limbs with arterial insufficiency and chronic ulceration treated without revascularization

Abstract

Limb salvage can be achieved in most patients with arterial insufficiency and uncomplicated chronic nonhealing limb ulcers using a program of wound management without revascularization. Healing proceeds slowly, however, requiring more than a year in many cases. Patients with an ABI <0.5 are more likely to require amputation. Interventions designed to improve outcomes in critical limb ischemia should stratify outcomes based on hemodynamic data and should include a comparative control group given the natural history of ischemic ulcers treated in a dedicated wound program.

Therapeutic Angiogenesis for Critical Limb Ischemia

“…Within a year of diagnosis, Ϸ20% of patients will die, 35% will require amputation, and the remainder will enter a more chronic state. 29,30 Prospective definition of these subpopulations is problematic and often imprecise, and these difficulties must be addressed during trial design and data analysis. A similar challenge is encountered with variability within the more chronic group that tends to be represented in clinical trials.…”

Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease

“…10,11 The correlation of low TP with increased mortality and decreased amputation free survival (AFS) has been demonstrated in patients with incompressible leg arteries. 12,13 In addition to AP and ABI, TP is used in the widely accepted TransAtlantic Inter-Society Consensus II (TASC II) classification of limb ischaemia.…”

Effect of Body Position on Skin Perfusion Pressure in Patients With Severe Peripheral Arterial Disease

“…It has been shown that limb salvage can even be achieved without revascularization in most patients with arterial insufficiency and uncomplicated chronic nonhealing limb ulcers when we treat them only with appropriate conservative management. 21 Against this background, and based on our results, maintaining Position III, sitting with the foot lowered vertically, may be ideal for the peripheral arterial circulation and a valuable, manageable option for patients with end-stage PAD. We do not usually pay attention to the body position of the patients, but it may be useful to consider positioning as adjunctive management.…”