Does the introduction of a vascular limb salvage (VaLS) service improve one-year amputation outcomes for patients with chronic limb-threatening ischaemia?
posted on 2020-12-03, 09:35authored byAndrew Nickinson, Jivka Dimitrova, John Houghton, Lauren Rate, Svetlana Dubkova, Hannah Lines, Laura Gray, Sarah Nduwayo, Tanya Payne, Rob Sayers, Robert Davies
Objective
Vascular limb salvage services are recommended by the Global Vascular Guidelines to help improve outcomes for patients with chronic limb-threatening ischaemia (CLTI), although their description within the literature is limited. This study reports the 12 month outcomes for an outpatient based vascular limb salvage (VaLS) clinic.
Methods
An analysis of a prospectively maintained database, involving all consecutive patients diagnosed with CLTI within the VaLS clinic from February 2018–February 2019, was undertaken. Data were compared with two comparator cohorts, identified from coding data: 1) patients managed prior to the clinic, between May 2017 and February 2018 (Pre-Clinic [PC]); and 2) patients managed outside of clinic, between February 2018 and February 2019 (Alternative Pathways [AP]). Freedom from major amputation at 12 months was the primary outcome. Kaplan–Meier plots and adjusted Cox’s proportional hazard models (aHR) were used to compare outcomes.
Results
Five hundred and sixty-six patients (VaLS 158, AP 173, PC 235) were included (median age 74 years). Patients managed within the VaLS cohort were statistically significantly more likely to be free from major amputation (90.5%) compared with both the AP (82.1%, aHR 0.52, 95% confidence interval [CI] 0.28 – 0.98, p = .041) and the PC (80.0%; aHR 0.50, 95% CI 0.28 – 0.91, p = .022) cohorts at 12 months, after adjustment for age, disease severity, and presence of diabetes.
Conclusion
This study supports the recommendations of the Global Vascular Guidelines that vascular limb salvage clinics may improve the rate of major amputation. Furthermore, the study provides a reproducible service model that delivers timely vascular assessment in an ambulatory setting. Further evaluation is required to assess longer term outcomes.
History
Citation
European Journal of Vascular and Endovascular Surgery
Volume 61, Issue 4, April 2021, Pages 612-619
Author affiliation
Department of Cardiovascular Sciences
Version
AM (Accepted Manuscript)
Published in
European Journal of Vascular and Endovascular Surgery