Clinical Management and Risk of Amputation among Patients with Critical Lower Limb Ischemia

Background: Our study aimed to analyze the clinical management of patients admitted with critical limb ischemia (CLI) at Second Surgical Clinic, Emergency County Hospital Cluj-Napoca and to identify the risk factors for amputation. Materials and methods: A three years retrospective study was conducted on subjects hospitalized for critical lower limb ischemia at Second Surgical Clinic, Emergency County Hospital Cluj-Napoca. The medical charts of patients with critical lower limb ischemia as principal diagnosis were reviewed and data were collected. Results: Four hundred and forty one patients with mean age of 66.22+/-10.40 years were included in the study. A significantly higher percentage of patients were male (M:F=4.25, p<0.0001). Smoking was positive on 67.12% of subject with significant higher percentage among men compared to women (76.75% vs. 26.19%, p<0.0001). Diabetes (F vs. M: 47.62% vs. 31.37%) and presence of ischemic heart disease (F vs. M: 64.29% vs. 47.34%) proved significantly more frequent in women compared to men (p<0.01). Ninety-nine bypasses were performed on the investigated sample (22.45%, 95% CI [18.59-26.76], values in square brackets are 95% confidence interval lower and upper bounds). Furthermore, more than half bypasses were at femuro-popliteal level (62.63% [52.53-71.71]). Other interventions included lumbar sympathectomy (1.81%), disarticulation (12.24%), amputation (17.01%) or soft tissues necrectomy (17.46%). Most patients received vasodilator (91.38%) and respectively anticoagulant (67.57%) treatment. Sepsis (5.22% [3.40-7.71]), bypass thrombosis (3.17% [1.81-5.44]), and lower limb haemorrhage (0.45% [0.00-1.81]) were the main complications. Favourable discharged status was observed on 85.26% of cases. Smoking proved a significant risk factors for amputation (OR=1.98 [1.06-3.70]). Conclusions: Bypass was the most frequent treatment strategy, with small percentage of complications while medical treatment included vasodilator and anticoagulant drugs. Smoking proved a significant risk factor for amputation.