Document Detail


A prognostic model for amputation in critical lower limb ischemia.
MedLine Citation:
PMID:  19366816     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In a (negative) multicenter randomized trial on management for inoperable critical lower limb ischemia, comparing spinal cord stimulation and best medical treatment, a number of pre-defined factors were analyzed for prognostic value. We included a radiological arterial disease score, modified from the SVS/ISCVS runoff score. The purpose of this analysis was to evaluate clinical factors and commonly used circulatory measurements for prognostic modeling in patients with critical lower limb ischemia. We determined the incidence of amputation and its relation to various pre-defined risk factors. A total of 120 patients with critical limb ischemia were included in the study. The integrity of circulation in the affected limb was evaluated on five levels: suprainguinal, infrainguinal, popliteal, infrapopliteal and pedal. A total radiological arterial disease score was calculated from 1 (full integrity of circulation) to 20 (maximally compromised state). We used Cox regression analysis to quantify prognostic effects and differential treatment (predictive) effects. Major amputation occurred in 33% of the patients at 6 months and in 51% at 2 years. The presence of ischemic skin lesions and the radiological arterial disease score were independent prognostic factors for amputation. Patients with ulcerations or gangrene had a higher amputation risk (hazard ratio 2.38, p = 0.018 and 2.30, p = 0.036 respectively) as well as patients with a higher radiological arterial disease score (hazard ratio 1.17 per increment, p = 0.003). We did not observe significant interactions between prognostic factors and the effect of spinal cord stimulation. In conclusion, in patients with critical lower limb ischemia, the presence of ischemic skin lesions and the described radiological arterial disease score can be used to estimate amputation risk.
Authors:
H M Klomp; E W Steyerberg; C H A Wittens; H van Urk; J D F Habbema;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Vascular medicine (London, England)     Volume:  14     ISSN:  1358-863X     ISO Abbreviation:  Vasc Med     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-15     Completed Date:  2009-07-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9610930     Medline TA:  Vasc Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  109-15     Citation Subset:  IM    
Affiliation:
Department of Public Health, Center for Clinical Decision Sciences, Erasmus MC. h.klomp@nki.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Amputation* / statistics & numerical data
Arterial Occlusive Diseases / complications,  radiography,  surgery,  therapy*
Cardiovascular Agents / therapeutic use*
Constriction, Pathologic
Critical Illness
Electric Stimulation Therapy* / methods
Female
Humans
Ischemia / etiology,  radiography,  surgery,  therapy*
Kaplan-Meiers Estimate
Leg Ulcer / etiology,  surgery
Lower Extremity / blood supply*
Male
Middle Aged
Netherlands
Proportional Hazards Models
Risk Assessment
Risk Factors
Severity of Illness Index
Spinal Nerves
Time Factors
Treatment Failure
Chemical
Reg. No./Substance:
0/Cardiovascular Agents
Investigator
Investigator/Affiliation:
J J A M van den Dungen / ; M J Staal / ; R J van Det / ; H E van de Aa / ; E A Kole / ; F L Moll / ; H A van Dijk / ; P J Theuvenet / ; J C Sier / ; N Lambooy / ; T I Yo / ; G Kazemier / ; C H A Wittens / ; N A J J duBois / ; A I Veeger / ; H van Urk / ; J Buth / ; E C M Bollen / ; J Lens / ; G H Spincemaille / ; W Hollander / ; A G M Hoofwijk / ; J H M Tordoir / ; T H A Bikkers / ; D van Lent / ; P J van Elk / ; M J H M Jacobs / ; D Th Ubbink / ; A C van der Ham /

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