Multidisciplinary Treatment for Critical limb Ischemia

Abstract

Objectives: We administered a multidisciplinary approach utilizing a combination of various treatments, in addition to revascularization, for critical limb ischemia (CLI). We herein report our treatments’ protocols and outcomes of this multidisciplinary approach in patients with CLI. Patients and Methods: Between January 2007 and September 2012, we treated 48 limbs of CLI by multidisciplinary treatments. Results: We administered the multidisciplinary treatments as follows: 18 limbs were treated with bypass surgery, 17 limbs were treated with endovascular treatment and 15 limbs were treated with hybrid treatment. As an additional therapy for revascularization; 16 limbs were treated with negative pressure wound therapy, 22 limbs were treated with maggot debridement therapy, 17 limbs were treated with hyperbaric oxygen therapy, three limbs were treated with low-density lipoprotein apheresis, seven limbs were treated with free tissue transfer and 17 limbs were treated with skin grafting. The limb salvage rate was 79%, and the 1-, 2- and 3-year amputation-free survival rates were 82.3%, 75.0% and 68.2%, respectively. Conclusions: Limb salvage might be achieved with multidisciplinary treatment for CLI, even when the patient has severe comorbidities. Such treatments should be considered in patients with extensive tissue loss before amputation is performed.