Results and Resource Implications of Treating End-stage Limb Ischaemia

Purpose: To quantitate the workload, resource requirement and outcome involved in the management of patients with chronic limb-threatening ischaemia when adopting an aggressive reconstructive policy. Methods: Prospective clinical audit of all patients with severe lower limb ischaemia presenting to a single specialist Vascular Surgeon in a 3 year period. Results: A total of 228 patients were treated with 275 severely ischaemic limbs. Two hundred and thirty-five limbs (85.5%) had procedures to improve blood supply, 19 (6.9%) underwent primary amputation and 21 (7.7%) were treated conservatively. The principal outcome measures were limb-salvage, death and graft patency. The cumulative limb-salvage, including those undergoing primary amputation, at 30 days, 1, 2, 3 and 4 years was 94.2%, 82.7%, 73.1%, 68.3% and 65.3% respectively. The cumulative patient survival was 91.7%, 69.2%, 58.1%, 47.9% and 40.6% for the same intervals. For reconstructive vascular surgery, excluding amputation and rehabilitation, a total of 383 hospital admissions were required covering 7343 hospital days, 64.5% of patients were managed in a single admission. The median duration of stay was 16 days for the first admission. Operations included 361 separate procedures to improve blood supply and 70 major limb amputations. Conclusions: The management of chronic limb-threatening ischaemia presents major resource implications. An acceptable limb-salvage rate can be achieved although there is a high initial mortality. In view of the poor overall survival any benefits for these patients should be viewed as relatively short-term objectives.