Conservative Treatment in Selected Patients with Severe Critical Limb Ischemia

Adriaan R. Thomas, Jelle W. Raats, Mare M. A. Lensvelt, Hans G. W. de Groot, Eelco J. Veen, Lijckle van der Laan

To assess the outcome of conservative treatment of severe critical limb ischemia (CLI) classified as Rutherford 5/6. The preferred therapy for CLI is either endovascular revascularization or bypass surgery. With a growing aged population with more serious comorbidities, these therapies are not always a viable option. Primary amputation leads to decreased mobility and a reduced quality of life. There is a lack of literature regarding the outcome of conservative therapy. Hospital charts were reviewed of all patients who were diagnosed with Rutherford classification 5-6 and received conservative treatment and lacked interventional options. Outcome measures were mortality, complete wound closure, and limb salvage rate. 38 patients were included with a median age of 80 years (range 57-97). The amputation rate during follow-up was 16 %. In 58 % of patients, complete wound closure was achieved. All-cause mortality was 58 % with a 2-year survivability rate of 55 %. Conservative management in our selected patients with CLI results in a moderate rate of wound closure and acceptable amputation rates albeit with a high mortality rate. For patients not eligible for endovascular revascularization or bypass surgery, conservative treatment could be a viable option besides primary limb amputation.