A novel vascular limb salvage clinic for the management of critical limb threatening ischaemia and diabetic foot disease: Our first year results

Background: Dedicated vascular limb salvage clinics may reduce delays in the management of critical limb threatening ischaemia (CLTI) and diabetic foot disease (DFD). We report the first year outcomes of a nurse-led, vascular limb salvage (VaLS) clinic for assessing patients with suspected CLTI and/or DFD, which aims to revascularise patients within 10 working days of referral, as recommended by the VSGBI’s Provision of Vascular Services (POVS) 2018. Method: Analysis of consecutive patients referred to the VaLS clinic over a 12 month period from inception (February 2018-February 2019). Data was prospectively collected on: a) time from referral to assessment and revascularisation and b) major amputation rates. Results: Two-hundred and ninety-nine cases (295 patients, median age=73 years, male=205, median follow-up=160 days) with suspected CLTI and/or DFD were assessed over a 12 month period. One-hundred and seventy-five (58.5%) cases occurred in patients with diabetes. General practice (n=133) and loco-regional diabetic foot clinics (n=101) were the leading referral sources. Overall, 128 cases (42.8%) underwent revascularisation following assessment, with primary endovascular being the most common technique (n=105, 82.0%). Median time from referral to assessment was 2.1 [IQR= 1.3-4.1] days and assessment to first revascularisation was 6.1 [4.0-11.0] days. Sixteen major amputations were performed (5.4%) (AKA=6, BKA=10) and 30 patients (10.2%) died during follow-up. Conclusions: The VaLS clinic has achieved rapid assessment and revascularisation times, facilitating the attainment of the POVS standard. Early major amputation rates are encouraging, however longer follow-up data is required to fully assess this model of care.