Long-term clinical outcomes in critical limb ischemia--A retrospective study of 181 patients.

OBJECTIVE : Critical limb ischemia (CLI) is the most severe manifestation of the pe - ripheral arterial disease. To date, several prognos - tic factors have been identified but the data of long-term follow-up in real life setting are scarce. The aim of our study is to describe a large group of CLI patients and identify possible prognostic factors, in a long-term follow-up. PATIENTS AND METHODS: Case-control, retro - spective study. 181 consecutive CLI patients with a minimum follow-up of 5 years were included in the study. RESULTS: Overall mortality was 15%, 24%, and 43% at 1, 2, and 5 years, respectively. Among known risk factors, only arterial hypertension was significantly correlated with survival rate; no differences were found between diabetics and non-diabetics. Patients treated with intravenous iloprost (46%), compared to untreated patients, showed a better ( p < 0.0001) long-term outcome in terms of major amputation (6% vs . 21%), sub - sequent vascular surgery (4% vs . 32%) and sur - vival rates (69% vs . 47%), at 5-year follow-up. Ma - jor amputations were significantly correlated with lower median forefoot transcutaneous val - ues of O 2 (0/3 mmHg, p < 0.001) and higher medi - an values of CO 2 (83/53 mmHg, p < 0.0001) in supine/dependent position, respectively. CONCLUSIONS: Our results confirm the poor prognosis of CLI patients in a very long-term fol - low-up and the severe metabolic damage caused by ischemia. A favourable role of iloprost was observed, in agreement with previous evidence in the literature.