Critical limb ischaemia: Management and outcome. Report of a national survey

Aim:A prospective national survey of patients with critical lower limb ischaemia was carried out to estimate the prevalence of critical lower limb ischaemia in Britain and Ireland; and to assess the average national outcome following treatment.Method:The surgeons were selected randomly but stratified according to the number of vascular surgical operations performed annually to match the profile of the vascular surgical population of the country as a whole.Outcome measures:The main outcome measures were the primary treatment intention; final treatment undertaken; duration of hospital stay; final outcome in terms of mortality and limb salvage rates and destination on discharge.Results:The data reveal that the extrapolated incidence of critical lower limb ischaemia in Great Britain and Ireland was 21 450 limbs in 20 000 patients, equating to a prevalence of 1 in 2500 of the population annually. Thirty per cent of the patients were diabetic. The overall mortality and amputation rates were 13.5% and 21.5% respectively. The mean duration of hospital stay was 25 days. Nearly 70% of patients were offered some form of revascularisation as the primary treatment optionwith a 75% chance of successful limb salvage. Amputation was associated with a significantly higher mortality (Chi square = 10.79, p = 0.001), longer hospital stay (t = 4.589, p < 0.0001) and a greater proportion of patients requiring long-term institutional support, than revascularisation. The ratio of revascularisation to amputation was 4:1. Surgeons with a lower annual experience of patients with vascular disease tended to undertake fewer revascularisations (Chi square = 6.737, p = 0.0094) and more amputations (Chi square = 10.445, p = 0.0012) than those treating larger numbers. The mean limb salvage rate achieved by surgeons with a lower throughput of vascular operations was significantly lower that achieved by other groups of surgeons (Chi square = 7.544, p = 0.0045)