Impact of different therapeutic alternatives in treatment of severe limb ischemia:: Experiences on 190 consecutive patients at a department of medical angiology

Background: Different therapies in consecutive patients (1987-1992) with chronic critical limb ischemia at a department of medical angiology, their short- and long-term outcome were investigated. Patients and methods: 190 patients (112 males, 78 females; age: 67 +/- 12 years); 78 in grade II, 112 in grade III according to Rutherford's classification. Therapeutic regimen: 1. vascular recanalisation by percutaneous transluminal angioplasty [PTA], local or systemic lysis; 2. surgical vascular reconstruction in case of impossibility, or failure of catheter procedures; 3. prostanoids and/or antibiotics; 4. local wound treatment including amputations. Results: Vascular recanalisation was attempted in 156/190 (82.1%): PTA in 116/190 surgical vascular reconstruction in 50/190, local in 24/190 and systemic lysis in 8/190 patients. Prostanoids were applied in 89/190 and antibiotics in 73/190 patients. At the time of dismissal 164/190 (86.3%) patients were clinically improved; 11/190 (5.8%) unchanged, 13/190 (6.8%) had undergone major amputations and 2/190 (1.1%) had died. After 2, 6 +/- 2,2 years 77 of the 141 patients, who were still alive, were reexamined Among these 77 patients 84.4% were in grade 0 or I, 15.6% in chronic critical limb ischemia. Furthermore 13.0% had been amputated since dismissal. Forty-nine of 190 (25.8%) patients had died 3,2 +/- 1,9 years after dismissal from hospital. Conclusion: Catheter techniques, mostly PTA, is possible in the majority of patients with chronic critical limb ischemia. Cooperation with vascular surgeons in case of technical impossibility or failure of catheter recanalisation is mandatory. Such a regimen yields satisfactory short- and long-term results and a low rate of complications.