Objectives: To evaluate whether revascularisation has any influence on the mortality rate, and the impact of old age in patients with critical limb ischaemia (CLI).Design: Analysis of Swedish Vascular Registry (Swedvasc) data.Patients ana methods: During 1987-1995, 3730 surgical and 1199 endovascular (PTA) procedures below the groin due to CLI were reported. At 1 year three groups were defined: "occluded, amputated"; "occluded, not amputated" and "patent". Survival was also calculated. Clinical outcome at I month and at 1 year was defined as: patient "alive, improved", "alive, not improved", "alive, amputated" and "dead". Two age groups: less than or equal to 75 years or and greater than or equal to 76 years were compared.Results: The mortality rate for the whole group was 5.3% at 1 month and 22.9% at 1 year, with no difference between the Surgery and PTA groups. Significantly more patients were alive and improved after surgery than after PTA at 1 month (82.3% vs. 77.7%) and at 1 year (49.6% vs. 44.3%). The amputation rate was 5.6% at 1 month and 14.4% at 1 year; 17% for diabetics. After surgery, the cumulative mortality rate did not differ between patients with a salvaged limb, irrespectively of patency of the re-construction, but was significantly higher after amputation. After PTA, only a reconstruction reported as parent was linked to the most favourable survival rate. The older patient group had a mortality rate of 6.4% at 1 month and 26.4% at 1 year, significantly higher than the younger group (3.8% and 17.6%, respectively). The amputation rate did not differ according to age. Significantly more patients were alive but nor improved in the older group.Conclusions: The outcome of surgery vs. PTA was similar regarding survival and amputation, but surgery resulted in a greater improvement although this might be due to selection. Older patients and those with an amputation had higher mortality rates.
AIMto compare the effect of perioperative dextran and low molecular weight heparin on early graft patency after femorodistal bypass surgery.DESIGNprospective randomised multicentre study.PATIENTS AND METHODSthree hundred and fourteen patients were randomised to dextran 70 or the low molecular weight heparin enoxaparin during and after femorodistal bypass surgery. Patency was evaluated at days 1, 5-7, 30 and 90.RESULTSthere was no difference in patency at any time point between the two regimens, the crude 90 days patency being 88 and 83%, respectively. There were significantly more patients with heart failure in the dextran group (12.8 vs 0.7%), with other side effects being evenly distributed.CONCLUSIONdextran 70 and the low molecular weight heparin enoxaparin have the same effect on 90 days femorodistal graft patency, but care must be taken using the dextran to patients with a potential heart insufficiency.
