One-year outcomes of patients with chronic-limb threatening ischaemia (CLTI) treated in an outpatient-based vascular limb salvage clinic show an improved rate of major amputation. Authors Andrew Nickinson (University of Leicester, Leicester, UK) and colleagues write in an online European Journal of Vascular and Endovascular Surgery (EJVES) article that their study supports the recommendations of the Global Vascular Guidelines and “provides a reproducible service model that delivers timely vascular assessment in an ambulatory setting”.
While vascular limb salvage services are recommended by the Global Vascular Guidelines to help improve outcomes for patients with CLTI, the authors write that literature on the topic is limited. It was the aim of this study, therefore, to provide data on the effect of treating CLTI patients in an outpatient-based vascular limb salvage clinic on amputation outcomes.
The George Davies Research Group, based at the University of Leicester, undertook an analysis of a prospectively-maintained database, involving all consecutive patients diagnosed with CLTI within the Leicester Vascular Limb Salvage (VaLS) clinic from February 2018 to February 2019.
They compared data 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.
Writing in EJVES, Nickinson et al detail that 566 patients were included (median age 74 years) in the study. They report that 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%; adjusted hazard ratio [aHR] 0.52; 95% confidence interval [CI] 0.28–0.98; p=0.041) and the PC (80%; aHR 0.5; 95% CI 0.28–0.91; p=0.022) cohorts at 12 months, after adjustment for age, disease severity, anti-platelets/lipid lowering therapies and presence of diabetes.
Following the publication of these results, Nickinson spoke to Vascular News about their significance: “We are really excited about the publication of these results in the EJVES, the culmination of a great deal of effect by the whole team in Leicester. Our sincere thanks go to George Davies Charitable Trust, whose generous donation has made the VaLS clinic a reality. Looking forward, a number of centres have now setup similar services across the UK and with the ongoing work of the Vascular Society’s PAD Quality Improvement Programme, it is great to see how interest is building across the UK in improving the outcomes for patients with CLTI.”