Useful predictors for critical limb ischemia in severely ischemic limbs

BACKGROUND: The aim of this paper was to determine useful predictors for critical limb ischemia (CLI) occurrence in severely ischemic limbs. The contralateral limbs of patients with unilateral CLI were evaluated, with special respect to pulse volume recording (PVR). METHODS: Retrospective analysis of 102 consecutive patients (110 limbs) with unilateral CLI. We excluded patients with bilateral CLI, or without PVR data. PVR data were automatically quantitatively expressed as upstroke time (UT) and percentage mean artery pressure (%MAP). The role of PVR parameters was examined in relation to arterial occlusive disease in the lower limbs. Baseline characteristics and non-invasive laboratory data (Mending Ankle Brachial Index [ABI] and PVR data) were analyzed as predictors for CLI. RESULTS: After exclusion, 73 contralateral limbs of unilateral CLI patients (mean age, 70 +/- 12 years; 51 male, 70%) were investigated. Fifty patients (68%) bad diabetes, and 41 patients (56%) were receiving hemodialysis. UT was longer in patients with aural arterial occlusive disease (214 55 terser 183 +/- 57 ms, P=0.02), although ABI was not different (P=0.31). In the follow-up of 19 +/- 12 months, 25 limbs progressed to CLI, and the cumulative incidence was 28% and 51% at 1 and 3 years, respectively. Multivariate analysis confirmed that abnormal %MAP (hazard ratio 5.9; 95% confidence interval, 1.8-27.0; P<0.01), coronary artery disease (CAD), and hypoalbuminemia were significant risk factors. CONCLUSIONS: %MAP, CAD, and hypoalbuminemia predicted CLI occurrence in the contralateral limbs of unilateral CLI patients.