Amputation Not Best Option for Circulation Woes?

WEDNESDAY, Aug. 15, 2018 (HealthDay News) -- Trying to restore blood flow may be better than amputation for patients with a serious leg circulation problem called critical limb ischemia, a new study contends. Critical limb ischemia is the most severe form of peripheral artery disease (PAD) and can lead to ulcers, gangrene and amputation, the researchers said. "Many patients who are diagnosed with critical limb ischemia are told amputation is their only option," explained study author Dr. Jihad Mustapha.

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Long-term survival, costs comparable for CLI revascularization techniques; amputation risk lower with endovascular strategy

Rates of major amputation following revascularization were lower after the endovascular technique. Compared with either revascularization strategy, patients with CLI who underwent primary major amputation had decreased survival time, increased risk for subsequent major amputation and greater costs. “The findings show that we should always attempt revascularization,” Jihad A. Mustapha, MD, interventional cardiologist and critical limb ischemia specialist at Advanced Cardiac and Vascular Amputation Prevention Centers in Grand Rapids, Michigan, told Cardiology Today’s Intervention. “Patients with both endovascular or surgical revascularization do much better than those undergoing primary amputation.”

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Limb Salvage Bests Amputation for Critical Limb Ischemia

Patients with advanced peripheral artery disease had worse survival and higher costs when major amputation was performed as first-line treatment, researchers found in a retrospective analysis. In a propensity score-matched analysis of Medicare beneficiaries with critical limb ischemia (CLI), 4-year survival rates were 38% with endovascular revascularization as the first-line strategy, 40% with surgical revascularization, and 23% with major amputation (P<0.001 for both versus amputation). Subsequent major amputation rates over follow-up were 6.5%, 9.6%, and 10.6%, respectively (P<0.001 for all comparisons), according to a group led by Jihad Mustapha, MD, of Advanced Cardiac & Vascular Amputation Prevention Centers in Grand Rapids, Michigan, reporting online in the Journal of the American Heart Association.

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For Treating Severe Peripheral Artery Disease, Blood Flow Restoration May Be Preferable to Amputation

For people with heart disease and diabetes, the possibility of amputation can be a serious concern. They run a higher risk of a blood flow blockage to the legs, which can sometimes become so severe that it leads to the loss of toes, feet, or lower legs. A new study published August 15, 2018, in the Journal of the American Heart Association has found that procedures to restore circulation may not only save limbs but also improve the odds of living longer compared with amputation. Plus, these revascularization treatments can be less costly. Many patients are told amputation is their only option because their healthcare providers lack awareness of currently available methods of revascularization to ward off amputation,” says Jihad Mustapha, MD, lead author of the study and an interventional cardiologist and critical limb ischemia specialist at Advanced Cardiac & Vascular Amputation Prevention Centers in Grand Rapids, Michigan. “This study has shown that both endovascular revascularization and surgical revascularization provide almost equal success for the same patients that were told they have no options [other than amputation]. In my opinion, every patient that has been told they need an amputation should ask for a second opinion.”

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The Critical Limb Ischemia (CLI) Global Society's mission is to improve quality of life by preventing amputations and death due to CLI.

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