Background: Although revascularization is the optimal treatment to avoid major amputation for critical limb ischemia (CLI) patients, mortality of CLI patients is extremity high. Therefore, despite of the revascularization, some patients die during the process of wound healing. In this study, we sought to investigate the predictors of mortality before wound healing and suggest the risk assessment to recommend best supportive care without revascularization in patients with CLI.
Methods: This study was a retrospective observational study. From January 2013 to March 2017, total of 120 patients had endovascular treatment (EVT) for Rutherford class V and VI limbs. Out of the patients, 81 patients who had complete wound healing and 24 patients who died before wound healing were enrolled.
Results: Mean follow up period was 506±439 days. Cox proportional hazards regression analysis showed there were two independent predictors:partially dependent and totally dependent of activity of daily living (ADL) compared with independent of ADL (hazards ratio[HR]:5.707;95% confidence interval [CI]:1.184 to 27.516;p=0.030) and less than 55% of left ventricular ejection fraction (LVEF) by transthoracic echocardiography (HR:11.122;95% CI:2.275 to 54.370;p=0.003). Kaplan-Meier curves showed six months mortality before wound healing without risk was 6.7%, with one risk (partially or totally dependent of ADL or LVEF<55%) was 7.9% and with both risks was 51.9% (p<0.001).
Conclusion: Both low ADL and low LVEF in patients with CLI are associated with high mortality before wound healing. Best supportive care without revascularization may have promising alternative for these patients.