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Researchers Offer Hope for Patients With Critical Limb Ischemia

Some patients who are in danger of losing an arm or leg due to hardening of the arteries have been getting more hopeful news from vascular surgeons at Beth Israel Deaconess Medical Center (BIDMC) in Boston.

People who have hardening of the arteries often feel no symptoms at all. But as they age, the disease can worsen and become critical limb ischemia (CLI), which is found in at least 12 percent of U.S. adults, according to data in the National Institutes of Health online resources. This is a serious illness that clogs the blood vessels so severely people may have painful leg cramps even while resting. Or worse-because their limbs aren’t getting enough blood flow, they develop sores that won’t heal or that become gangrenous.

Most of the time, vascular surgeons can prevent amputation with procedures such as arterial bypass or by installing a stent. Their patients often ask if the procedure will save their limb.

“That’s what patients really want to know. Losing a limb is a life-changing event,” said study lead Katie Shean, MD.

When asked about the probability of limb loss, or loss of life, many surgeons use a statistic on how many people live for ten years after surgery. But for sick, elderly patients, such as an 83-year-old with diabetes and CLI, BIDMC researchers have redefined success based on different data and the likelihood that a particular patient will live the rest of his or her life with that limb intact. And that’s good news-these rates tend to be much better.

One recent study indicated that “diabetics getting vein grafts typically would have been told they had a 50 percent chance of keeping their limbs; however, now using our lifelong limb salvage calculation, we know they actually had an 88 percent chance of living out their lives with the affected limb intact,” said BIDMC vascular surgeon Frank W. LoGerfo, MD.

The researchers at BIDMC recently reviewed seven years of records for patients who experienced a first-time surgical intervention for one of the three symptoms. The following shows the likelihood that patients with each condition will keep their limbs:

  • Resting leg pain-91 percent
  • Ulcer-86 percent
  • Gangrene-78 percent

LoGerfo finds the new way of calculating risk to be encouraging for his patients. Previously he could tell them what their ten-year chances were, but, “I had no precise measure of that outcome. I knew I was not seeing 50 percent of my patients returning for amputation. Over the years that prompted me to look for a new way to measure their outcomes.”

This article was adapted from information provided by the Society for Vascular Surgery.