The treatment of critical lower limb ischemia: The evaluation of risk factors in the outcome

Aim. Limb salvage must be considered the goal of the treatment of critical lower limb ischemia (CI). The aim of this study is a retrospective evaluation of the impact of risk factors on the outcome of patients affected by CI. Methods. A total of 297 consecutive patients were submitted to surgical or endovascular treatment for critical leg ischemia at our institution. Risk factors were examined according to age, female gender, distal vessels run-off and diabetes. Cumulative patency rate, limb salvage and mortality rate were classified as the outcome of these patients. Results. Cumulative patency was not affected by gender and age, whereas a negative influence was observed in relation to diabetes (P=0.001), more evident in female (P<0.001). The limb salvage rate was 91.58%: 25 patients (8 females) underwent major amputations: 7 below knee and 18 above knee amputations were performed within 30 days. In our series, limb salvage was not affected by age and gender: risk stratification analysis did not show any statistically significant differences. However, an increased incidence of major amputations was demonstrated in patients affected by diabetes (P=0.001), mostly in female diabetic patients (P=0.009). Postoperative 30-day mortality rate was respectively 0.66% and 0.34% for surgical and endovascular treatment: global mortality in both groups was 1.01%. There were no differences between genders, whereas mortality was higher in diabetic patients (P<0.001) at 36 months, and this rate has been demonstrated much higher in female patients affected by IC and diabetes (P=0.02). Conclusion. Age and gender as risk factors did not adversely influence the outcome of CI patients submitted to surgical revascularization and/or endovascular treatment. In our experience a lower cumulative patency, a higher incidence of major amputation and a higher mortality rate were observed in diabetic patients, particularly in female diabetic patients.