A new study published in the Journal of the American Heart Association shows that amputation is not always the best option for patients with critical limb ischaemia (CLI).
CLI is a severe obstruction of the arteries which reduces blood flow to the extremities. It represents the most advanced form of peripheral artery disease and is characterised by symptoms including rest pain, non-healing ulcers and gangrene. The condition is most common amongst the elderly, smokers and diabetics, and is often treated by amputation of the affected limb.
Dr Jihad Mustapha, from the Advanced Cardiac & Vascular Amputation Prevention Centers in Michigan, recently published findings in the Journal of the American Heart Association to show that amputation often results in poor outcomes for patients with CLI, and that other treatment options may be preferable. Dr Mustapha led a team which reviewed over 72,000 patients in the United States who had been diagnosed with CLI between 2010 and 2015. Survival rates for amputated patients were just 23%, whereas other treatment options, such as angioplasty (surgery to widen narrowed or blocked arteries) and vein grafting (to bypass blocked blood vessels) yielded much better survival rates of 38% and 40% respectively. Those who initially underwent either minor or major amputation were also more likely to require further major amputation over the next four years. Furthermore, annual follow-up healthcare costs were calculated as $55,700 for patients who underwent amputations, while costs associated with follow-up care for angioplasty patients and vein graft patients were $49,700. In summary, researchers found that amputation seems to lead to lower survival rates, higher risk of subsequent major amputation and higher follow-up healthcare costs compared to alternative treatment options for CLI.