Aim: The present study aimed at identifying the pattern of patients with critical limb ischemia (CLI) compared with those with peripheral arterial occlusive disease (PAOD).
Materials and methods: A four-year retrospective study was conducted with patients hospitalized in the Second Surgical Clinic at the Emergency County Hospital Cluj-Napoca. The medical charts of patients with PAOD (n=466) and CLI (n=223) were reviewed and data were collected.
Results: The study included 689 patients; mean age 67 years for PAOD patients and 65 years for CLI patients. A significantly higher percentage of patients were male in both groups (79.25%, P < 0.0001). Most of the patients in both groups had received at least a secondary education (P < 0.0001). Most of the subjects in both groups were smokers (>71.30%) with no difference between groups (P = 0.566). No significant differences were found between the groups in comorbidities (diabetes, arterial blood hypertension, cardiac ischemia, rhythm disorders, P > 0.05). There were more CLI patients that were overweight than overweight patients with PAOD (P = 0.0004). High serum cholesterol (>200 mg/dL) and triglycerides (>150 mg/dL) levels were found in the CLI group (P < 0.05). Age was identified as a risk factors for amputation (OR = 1.03, 95%Cl [1.01−1.05], P = 0.0012).
Conclusions: The profile of a patient with critical limb ischemia and peripheral arterial occlusive disease is a 65-67-year-old male smoker with at least a secondary education. The CLI patient is overweight with pathological serum levels of cholesterol and triglycerides.
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1. Norgren L, Hiatt WR, Dormandy JA, et al. Intersociety consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg 2007;33:S5-S75.
2. Rowe VL, Lee W, Weaver FA, et al. Patterns of treatment for peripheral arterial disease in the United States: 1996-2005. J Vasc Surg 2009;49:910-7.
3. Kanne WB. Risk factors for atherosclerotic cardiovascular outcomes in different arterial territories. J Cardiovasc Risk 1994;1:333-9.
4. Antoniou GA, Georgakarakos EI, Antoniou SA, et al. Does endovascular treatment of infra-inguinal arterial disease with drug-eluting stents offer better results than angioplasty with or without bare metal stents? Interact Cardiovasc Thorac Surg 2014;19(2):282-5.
5. Jens S, Conijn AP, Koelemay MJ, et al. Randomized trials for endovascular treatment of infrainguinal arterial disease: systematic review and meta-analysis (Part 2: Below the knee). Eur J Vasc Endovasc Surg 2014;47(5):536-44.
6. Jäntschi L, Bolboacă SD. Exact probabilities and confi dence limits for binomial samples: applied to the difference between two proportions. The Scientifi c World Journal 2010;10:865-78.
8. Chen DC, Armstrong EJ, Singh GD, et al. Adherence to guideline-recommended therapies among patients with diverse manifestations of vascular disease. Vasc Health Risk Manag 2015;11:185-92.
9. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/ AHA 2005 Practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic. Circulation 2006;113:e463-e654.
10. Constantinescu MI, Constantinescu DP, Chiş B, et al. Infl uence of risk factors and comorbidities on the successful therapy and survival of patients with critical limb ischemia. Clujul Med 2013;86(1):57-64.
11. Norgren L, Hiatt WR, Dormandy JA, et al. TASC II Working Group. Inter-Society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg 2007;33(1):S1-S75.
12. Hultgren R, Olofsson P, Wahlberg E. Gender differences in patients treated for critical limb ischemia. Eur J Vasc Endovasc Surg 2005;29(3):295-300.
13. Corey MR, St Julien J, Miller C, et al. Patient education level affects functionality and long term mortality after major lower extremity amputation. Am J Surg 2012;204(5):626-30.
14. Murata N, Soga Y, Iida O, et al. Complex relationship of body mass index with mortality in patients with critical limb ischemia undergoing endovascular treatment. Eur J Vasc Endovasc Surg 2015;49(3):297-305.
16. Ostchega Y, Paulose-Ram R, Dillon CF, et al. Prevalence of peripheral arterial disease and risk factors in persons aged 60 and older: data from the National Health and Nutrition Examination Survey 1999-2004. J Am Geriatr Soc 2007;55(4):583-9.
17. Sotoda Y, Hirooka S, Orita H, et al. [Recent knowledge of smoking and peripheral arterial disease in lower extremities]. Nihon Eiseigaku Zasshi 2015;70(3):211-9 [Japanese].
18. Lu L, Mackay DF, Pell JP. Meta-analysis of the association between cigarette smoking and peripheral arterial disease. Heart 2014;100(5):414-23.
19. Emdin CA, Anderson SG, Callender T, et al. Usual blood pressure, peripheral arterial disease, and vascular risk: cohort study of 4.2 million adults. BMJ 2015;351:h4865.
20. Priest JR, Nead KT, Wehner MR, et al. Self-reported history of childhood smoking is associated with an increased risk for peripheral arterial disease independent of lifetime smoking burden. PLoS One 2014;9(2):e88972.
21. Kannel WB, McGee DL, Castelli WP. Latest perspectives on cigarette smoking and cardiovascular disease: the Framingham study. J Card Rehabil 1984;4:267-77.
22. Fowkes FG, Housley E, Riemersma RA, et al. Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Arterial Study. Am J Epidemiol 1992;135(4):331-40.
23. Nehler MR, Hiatt WR, Taylor LM. Is revascularization and limb salvage always the best treatment for critical limb ischemia? J Vasc Surg 2003;37:704-8.
24. Norwegian Pentoxifyllin Multicenter Trial Group. Efficacy and clinical tolerance of parenteral pentoxifylline. Int Angiol 1996;15:75-80.
25. Brock FE, Abri O, Baitsch G, et al. [Iloprost in the treatment of ischemic tissue lesions in diabetics. Results of a placebo-controlled multicenter study with a stable prostacyclin derivative.] Schweiz Med Wochenschr 1990;120:1477-82 [German].
26. Brass EP, Anthony R, Dormandy J, et al. Parenteral therapy with lipo-ecraprost, a lipid-based formulation of a PGE1 analog, does not alter six-month outcomes in patients with critical leg ischemia. J Vasc Surg 2006;43:752-9.
27. Murphy TP, Ariaratnam NS, Carney WI Jr, et al. Aortoiliac insuffi ciency: long-term experience with stent placement for treatment. Radiology 2004;231:243-9.
28. Shojaiefard A, Khorgami Z, Larijani B. Independent risk factors for amputation in diabetic foot. Int J Diabetes Dev Ctries 2008;28(2):32-7.