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Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
Online ISSN 1827-191X
Nicola TROISI 1, Leonardo ERCOLINI 1, Emiliano CHISCI 1, Enrico BARBANTI 1, Elisa PERETTI 2, Marco SETTI 2, Antonino PITÌ 3, Stefano MICHELAGNOLI 1
1 Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy; 2 Section of Vascular Surgery, Department of Cardiovascular Diseases, Humanitas Gavazzeni Clinic, Bergamo, Italy; 3 Section of Interventional Cardiology, Department of Cardiovascular Diseases, Humanitas Gavazzeni Clinic, Bergamo, Italy
BACKGROUND: The aim of this study was to evaluate early and one-year outcomes of urgent endovascular treatment in patients with acute on chronic critical limb ischemia (CLI).
METHODS: Between January 2012 and December 2013 104 patients with acute on chronic CLI (Rutherford class 4-6) were referred to two tertiary hospitals. In all cases the urgent endovascular revascularization was considered the first therapeutic option. Twenty-seven patients (26%) were excluded from this approach (long occlusion >30 cm of the femoro-popliteal tract and/or massive gangrene with abscess/osteomyelitis/necrotizing fasciitis).
RESULTS: Seventy-seven out of 104 patients received an urgent endovascular treatment. They were predominantly male (43, 55.8%) with a mean age of 76.5 years (range 47-94). In 67 cases (87%) the patients had leg/foot lesions (54, 70.1%, Rutherford class 5, and 13, 16.9%, Rutherford class 6). During the follow-up (mean duration 6.2 months, range 1-24 months) the healing of the lesions and the relief of rest pain were obtained in 46 cases (59.7%). Estimated one-year primary patency, primary assisted patency, secondary patency, and limb salvage rates were 63.6%, 68.3, 69%, and 84.1%, respectively. At uni- and multivariate analysis patients in Rutherford class 6 showed poor results in terms of primary patency, primary assisted patency, secondary patency, and limb salvage (P<0.001).
CONCLUSIONS: Urgent endovascular treatment in selected patients with acute on chronic CLI represents a safe and effective option with good results in terms of healing of the ischemic lesions, relief of rest pain, and limb salvage. Patients in Rutherford class 6 showed fewer benefits with this approach.