Current practice of first-line treatment strategies in patients with critical limb ischemia

Theodosios Bisdas*, Matthias Borowski, Giovanni Torsello, Farzin Adili, Kai Balzer, Thomas Betz, Arend Billing, Dittmar Böckler, Daniel Brixner, Sebastian E. Debus, Konstantinos P. Donas, Hans Henning Eckstein, Hans Joachim Florek, Asimakis Gkremoutis, Reinhardt Grundmann, Thomas Hupp, Tobias Keck, Joachim Gerß, Wojciech Klonek, Werner LangUte Ludwig, Björn May, Alexander Meyer, Bernhard Mühling, Alexander Oberhuber, Holger Reinecke, Christian Reinhold, Ralf Gerhard Ritter, Hubert Schelzig, Christian Schlensack, Thomas Schmitz-Rixen, Karl Ludwig Schulte, Matthias Spohn, Konstantinos Stavroulakis, Markus Steinbauer, Martin Storck, Matthias Trede, Barbara Weis-Müller, Heiner Wenk, Thomas Zeller, Alexander Zimmermann

*Korrespondierende/r Autor/-in für diese Arbeit
73 Zitate (Scopus)


Objective Critical limb ischemia (CLI) is growing in global prevalence and is associated with high rates of limb loss and mortality. However, a relevant gap of evidence about the most optimal treatment strategy still exists. The aim of this study of the prospective, multicenter First-Line Treatments in Patients With Critical Limb Ischemia (CRITISCH) registry was to assess the current practice of all first-line treatments strategies in CLI patients in German vascular centers. Methods Between January 2013 and September 2014, five first-line treatment strategies - endovascular revascularization (ER), bypass surgery (BS), femoral/profundal artery patchplasty (FAP), conservative treatment, and primary amputation - were determined among CLI patients in 27 vascular tertiary centers. The main composite end point was major amputation or death, or both, during the hospital stay. Secondary outcomes were hemodynamic failure, major adverse cardiovascular and cerebral events, and reintervention. Univariate logistic models were additionally built to preselect possible risk factors for either event, which were then used as candidates for a multivariate logistic model. Results The study included 1200 consecutive patients. First-line treatment of choice was ER in 642 patients (53.4%), BS in 284 (23.7%), FAP in 126 (10.5%), conservative treatment in 118 (9.8%), and primary amputation in 30 (2.5%). The composite end point was met in 24 patients (4%) after ER, in 17 (6%) after BS, in 8 (6%) after FAP, and in 9 (8%) after conservative treatment (P =.172). The highest rate of in-hospital death was observed after primary amputation (10%) and of hemodynamic failure after conservative treatment (91%). Major adverse cardiovascular and cerebral events developed in 4% of patients after ER, in 5% after BS, in 6% after FAP, in 5% after conservative treatment, and in 13% after primary amputation. The reintervention rate was 8%, 14%, 6%, 5%, and 3% in each group, respectively. In the multivariate regression model, coronary artery disease (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.42-6.17) and previous myocardial infarction (PMI) <6 months (OR, 3.67, 95% CI, 1.51-8.88) were identified as risk factors for the composite end point. Risk factors for amputation were dialysis (OR, 3.31, 95% CI, 1.44-7.58) and PMI (OR, 3.26, 95% CI, 1.23-8.36) and for death, BS compared with ER (OR, 3.32; 95% CI, 1.10-10.0), renal insufficiency without dialysis (OR, 6.34; 95% CI, 1.71-23.5), and PMI (OR, 7.41; 95% CI, 2.11-26.0). Conclusions The CRITISCH registry revealed ER as the most common first-line approach in CLI patients. Coronary artery disease and PMI <6 months were independent risk factors for the composite end point. Special attention should be also paid to CLI patients with renal insufficiency, with or without dialysis, and those undergoing BS.

ZeitschriftJournal of Vascular Surgery
Seiten (von - bis)965-973.e3
PublikationsstatusVeröffentlicht - 01.10.2015


  • 205-25 Allgemein- und Viszeralchirurgie