Critical limb ischaemia: management and outcome. Report of a national survey. The Vascular Surgical Society of Great Britain and Ireland.

Abstract

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. 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. 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. 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 option with 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).