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Sequential Compression Biomechanical Device Versus Primary Amputation in Patients With Critical Limb Ischemia.
- Source :
-
Vascular & Endovascular Surgery . Oct2013, Vol. 47 Issue 7, p532-539. 8p. - Publication Year :
- 2013
-
Abstract
- Introduction: Patients with critical limb ischemia (CLI), who are unsuitable for intervention, face the consequence of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients. Objectives: To assess the outcome of SCBD in patients with severe CLI who are unsuitable for revascularization. Primary end points were limb salvage and 30-day mortality. Methods: From 2005 to 2012, 189 patients with severe CLI were not suitable for revascularization. In all, 171 joined the SCBD program. We match controlled 75 primary amputations. Results: All patients were Rutherford category 4 or higher. Sustained clinical improvement was 68% at 1 year. Mean toe pressure increased from 19.9 to 35.42 mm Hg, P < .0001. Mean popliteal flow increased from 35.44 to 55.91 cm/sec, P < .0001. The 30-day mortality was 0.6%. Limb salvage was 94% at 5 years. Freedom from major adverse clinical events was 62.5%. All-cause survival was 69%. Median cost of managing a primary amputation patient is €29 815 compared to €3985 for SCBD. We treated 171 patients with artassist at a cost of €681 965. However, primary amputation for 75 patients cost €2 236 125. Conclusion: The SCBD therapy is a cost-effective and clinically effective solution in patients with CLI having no option of revascularization. It provides adequate limb salvage while providing relief of rest pain without any intervention. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ISCHEMIA treatment
*AMPUTATION
*CHI-squared test
*CONFIDENCE intervals
*COST effectiveness
*HEMODYNAMICS
*LEG
*LONGITUDINAL method
*MORTALITY
*HEALTH outcome assessment
*SURVIVAL analysis (Biometry)
*T-test (Statistics)
*U-statistics
*TREATMENT effectiveness
*PROPORTIONAL hazards models
*RETROSPECTIVE studies
*ANKLE brachial index
*COMPRESSION therapy
*REVASCULARIZATION (Surgery)
*SALVAGE therapy
*DESCRIPTIVE statistics
*KAPLAN-Meier estimator
Subjects
Details
- Language :
- English
- ISSN :
- 15385744
- Volume :
- 47
- Issue :
- 7
- Database :
- Academic Search Index
- Journal :
- Vascular & Endovascular Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 90310898
- Full Text :
- https://doi.org/10.1177/1538574413499413