Analysis of the Elective Treatment Process for Critical Limb lschaemia with Tissue Loss : Diabetic Patients Require Rapid Revascularisation

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Noronen , K , Saarinen , E , Albäck , A & Venermo , M 2017 , ' Analysis of the Elective Treatment Process for Critical Limb lschaemia with Tissue Loss : Diabetic Patients Require Rapid Revascularisation ' , European Journal of Vascular and Endovascular Surgery , vol. 53 , no. 2 , pp. 206-213 . https://doi.org/10.1016/j.ejvs.2016.10.023

Title: Analysis of the Elective Treatment Process for Critical Limb lschaemia with Tissue Loss : Diabetic Patients Require Rapid Revascularisation
Author: Noronen, Katariina; Saarinen, Eva; Albäck, Anders; Venermo, Maarit
Other contributor: University of Helsinki, Verisuonikirurgian yksikkö
University of Helsinki, Verisuonikirurgian yksikkö
University of Helsinki, Verisuonikirurgian yksikkö
University of Helsinki, Clinicum



Date: 2017-02
Language: eng
Number of pages: 8
Belongs to series: European Journal of Vascular and Endovascular Surgery
ISSN: 1078-5884
DOI: https://doi.org/10.1016/j.ejvs.2016.10.023
URI: http://hdl.handle.net/10138/233923
Abstract: Objectives: The number of elderly people is increasing; inevitably, the result will be more patients with critical limb ischaemia (CLI) in the future. Tissue loss in CLI is related to a high risk of major amputation. The aim of this study was to analyze the treatment process from referral to revascularisation, to discover possible delays and reasons behind them, and to distinguish patients benefitting the most from early revascularisation. Methods: A retrospective analysis was performed of 394 consecutive patients with a combined 447 affected limbs, referred to the outpatient clinic during 2010-2011 for tissue loss of suspected ischaemic origin. Results: For 246 limbs revascularisation was scheduled. After changes in the initial treatment strategy, endovascular treatment (ET) was performed on 221 and open surgery (OS) on 45 limbs. Notably there was crossover after ET in 17.0% of the procedures, and re-revascularisations were required in 40.1% after ET and 31.1% after OS. The median time from referral to revascularisation was 43 days (range 1-657 days) with no significant difference between ET and OS. For 29 (11.8%) patients the ischaemic limb required an emergency operation scheduled at the first visit to the outpatient clinic. For 25 (10.2%) patients the situation worsened while waiting for elective revascularisation and an emergency procedure was performed. Diabetic patients formed the majority of the study population; with 159 diabetic feet undergoing revascularisation. In multivariate analysis, diabetes was associated with poor limb salvage. When revascularisation was achieved within 2 weeks, no difference was seen in limb salvage. However, when the delay from first visit to revascularisation exceeded 2 weeks, limb salvage was significantly poorer in diabetic patients. Conclusions: Diabetic ulcers always require vascular evaluation, and when.ischaemia is suspected the diagnostics should be organised rapidly to ensure revascularisation without delay, according to this study within 2 weeks from the first evaluation. (C) 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Subject: Diabetic foot
Ischaemic ulcer
BYPASS-SURGERY
FOOT ULCERS
DISEASE
PREVENTION
AMPUTATION
DELAY
3126 Surgery, anesthesiology, intensive care, radiology
3121 General medicine, internal medicine and other clinical medicine
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