The influence of arterial reconstructive surgery on the outcome of critical leg ischaemia

Objectives:

To analyse the effect of an aggressive vascular reconstruction policy on the outcome of critical leg ischaemia in a defined population.

Design:

A retrospective survey of surgical in-hospital patient data related to population data in the study region over 22 years (1970–1991).

Setting:

Vasa Central Hospital district in Western Finland. The area is served by one Central Hospital and two District Hospitals.

Materials:

The population of 165 000 at the beginning of the study and 178 000 at the end of the study needing 977 interventions for chronic critical leg ischaemia (CLI), 397 for acute ischaemia and 313 for noncritical leg ischaemia.

Chief outcome measures:

Total and age-group related major amputation rates, mortality, rates of arterial interventions, limb salvage rate.

Main results:

The population > 65 years of age increased by 50% from 1970 to 1991. Major amputation rates increased 2.5 times from 1970 to 1981. The mean age at amputation increased from 71 to 78 years and at reconstruction from 68 to 74 years. The increase in numbers of reconstructions for CLI by 100% from 1980 onwards was associated with a reduction in amputation rate by 60% from 1983 to 1991. The 1- and 5-year survival rate after amputation was 55 and 20% and after reconstruction 83 and 45%. After reconstruction 1-, 3- and 5-year limb salvage rates were 83, 78 and 77% and limb salvage until death was 74%.

Conclusions:

With an aggressive reconstruction policy in CLI it is possible to reduce amputation rates with a reasonable mortality and morbidity even in patients in the 8th and 9th decade of life.