The natural history of chronic leg ischemia

McGrath, Michael A.; Graham, Antony R.; Hill, David A.; Lord, Reginald S. A.; Tracy, G. D.

doi:10.1007/bf01658078

Cited by 14 publications

(5 citation statements)

References 15 publications

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“…Similarly, diabetic patients are approximately 10 times more likely to need a major amputation than nondiabetic PAD patients [28]. Smoking seems to have an additive effect and, in any case, major amputation is more frequent among PAD who are heavy smokers [29], independently from the presence of diabetes.…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 96%

Critical Limb Ischemia: Definition and Natural History

Novo¹,

Coppola

Milio

2004

CDTCHD

127

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The term critical limb ischemia refers to a condition characterized by chronic ischemic at-rest pain, ulcers, or gangrene in one or both legs attributable to objectively proven arterial occlusive disease. Critical limb ischemia implies chronicity and is to be distinguished from acute limb ischemia. Its incidence is approximately 500 to 1000 per million year, with the highest rates among older subjects, smokers and diabetics. The rate of primary amputation ranges from 10% to 40%, and was performed only when no graftable distal vessels were present, or in neurologically impaired or hopelessly nonambulatory patients. Contrarily, in some highly specialized and aggressive centres about 90% of patients with CLI had an attempted revascularization. Furthermore, patients with critical limb ischemia have an elevated risk of future myocardial infarction, stroke and vascular death, 3-fold higher than patients with intermittent claudication. Therefore, due to its negative impact on the quality of life and the poor prognosis both in terms of limb salvage and survival, critical limb ischemia is a critical public health issue.

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Section: Epidemiology and Risk Factorsmentioning

confidence: 96%

Critical Limb Ischemia: Definition and Natural History

Novo¹,

Coppola

Milio

2004

CDTCHD

127

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“…The 5-year mortality for CLI patients is 50% to 60%, with coronary events and strokes accounting for at least 70% of the deaths. [2][3][4][5][6][7] However, efforts to understand the natural history and compare outcomes of alternative therapies have been hindered by inconsistencies in the definition and the heterogeneity of clinical presentation.…”

mentioning

confidence: 99%

The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI)

Mills

Conte

Armstrong

et al. 2014

Journal of Vascular Surgery

1,262

989

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Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population.

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“…The risk increases with the number of cigarettes smoked, and becomes weaker with time after smoking cessation. 28 Furthermore, amputations are more common in IC patients who have been heavy smokers. 28,29 The presence of CLI before the age of 70 was in our data, however, not significantly higher among current smokers compared to never and former smokers.…”

Section: Discussionmentioning

confidence: 99%

“…28 Furthermore, amputations are more common in IC patients who have been heavy smokers. 28,29 The presence of CLI before the age of 70 was in our data, however, not significantly higher among current smokers compared to never and former smokers. Nevertheless, current and former smokers combined had a substantially higher prevalence of CLI compared to never smokers.…”

Section: Discussionmentioning

confidence: 99%