Surgical treatment of chronic critical leg ischaemia. A five-year follow-up of survival, mobility, and treatment level.

OBJECTIVE

To evaluate mobility and care level required after amputation and arterial reconstruction for chronic critical leg ischaemia.

DESIGN

A 5 year follow up study in three hospitals serving a defined population.

SETTING

One regional and two district hospitals, Finland.

PATIENTS

117 Consecutive patients.

OUTCOME MEASURES

Survival, amputations, mobility, and care level required.

MAIN RESULTS

66 Primary reconstructions, 51 primary and 35 later major amputations were done. Preoperatively 27 (53%) of the patients who underwent a primary amputation were in permanent institutional care. Of 86 patients who were living outside an institution, 62 (72%) had a reconstruction. One and five year mortality were 43% and 84% after amputation, and 20% and 57% after reconstruction, respectively. Of the patients who had had an amputation 10% were able to walk and 25% could manage to live outside an institution. Mobility and treatment level after primary and secondary amputations were similar. Forty seven (71%) of the patients who had had a reconstruction did not have an amputation. All patients whose reconstructions were successful preserved their walking ability and independent living.

CONCLUSION

To maintain mobility and an independent living in patients with chronic critical leg ischaemia it is necessary to do a reconstruction that can salvage the leg. In old, institutionalised patients chronic critical leg ischaemia is often the harbinger of approaching death and then amputation is the only possible solution.