Arterial intervention and reduction in amputation for chronic critical leg ischaemia

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Abstract
Background: Untreated chronic critical leg ischaemia (CLI) usually leads to an amputation or death of a patient. Surgical and endovascular interventions may improve arterial flow. Long infrainguinal reconstruction may be the most useful method for preventing amputations. The value of different reconstruction methods was assessed by their impact on amputation incidence. Methods: A nationwide 2-year analysis of the incidence of major amputations and reconstructions for CLI was done in Finland (population 5·1 million). Incidences were compared in hospital regions with more than 150 000 inhabitants. Results: The overall amputation incidence was 216 per million inhabitants per year. The corresponding incidence of arterial reconstructions was 203 per million inhabitants per year. There were large variations in the incidence of amputations and reconstructions; 20-fold differences in infrapopliteal surgical reconstructions and 30-fold differences in endovascular procedures were found. There was a correlation between a high incidence of infrapopliteal surgical reconstructions and a low incidence of amputations. This correlation was found for below-knee amputations only. Conclusion: These results suggest that long surgical reconstructions improving perfusion directly to the ischaemic tissue can improve leg salvage.