‘No-Option Chronic Limb-Threatening Ischaemia: What Can We Do To Save Limb?

Abstract

The aim of this study is to describe the characteristics, the management and the outcome of a series of patients with no-option critical limb ischemia (CLI) treated with a conservative multidisciplinary combined approach including best wound care, NPWT and dermal substitutes. The primary end was limb salvage and 1-year amputation-free survival. The secondary end was mortality and healing time of lesion. Between January 2016 and January 2021, 76 patients with no options CLI were admitted. In 14 patients, there was a failure in distal revascularization with a persistent CLI after the procedure. In 58 patients, revascularization was not feasible. Despite the persistent CLI, a group of patients of this cohort obtained no progression of CLI, complete wound healing treated with surgical debridement or distal amputation and application of NPWT in association with dermal substitute .Any superimposed infection was treated with antimicrobials. Pain was controlled with analgesics. Overall limb was saved in 72 % of the cases. A 1-year survival was 84%.Use of NPWT, dermal substitutes combined with a conservative foot surgery with an approach with minor amputation in patients with no-option CLI may save patient limb and life