Some patients who are in danger of losing an arm or leg due to hardening of the arteries have been getting more hopeful news from vascular surgeons at Beth Israel Deaconess Medical Center (BIDMC) in Boston.
When people have hardening of the arteries, they often feel no symptoms at all. But as they age, the disease can worsen and become critical limb ischemia, or CLI. This is a serious illness that clogs the blood vessels so severely people may have painful leg cramps even while resting. Or worse – because their limbs aren’t getting enough blood flow, they develop sores that won’t heal or become gangrenous.
Most of the time, vascular surgeons can prevent amputation with procedures such as arterial bypass or installing a stent. Their patients often ask if the procedure will save their limb. “That’s what patients really want to know. Losing a limb is a life-changing event,” said study lead Dr. Katie Shean. “It can be intimidating for patients to think about how they would get around and do basic tasks for themselves. It’s not just a loss of a major part of their body, it’s also the loss of independence.”
When asked about the probability of limb loss, or life, many surgeons use a statistic on how many people live for 10 years after surgery. But for sick, elderly patients, such as an 83-year-old with diabetes and CLI, BIDMC researchers have redefined success based on different data and the likelihood that a particular patient will live the rest of his or her life with that limb intact. And that’s good news – these rates tend to be much better.
In one recent study, explained BIDMC vascular surgeon Dr. Frank W. LoGerfo, a member of the Society for Vascular Surgery, “diabetics getting vein grafts typically would have been told they had a 50 percent chance of keeping their limbs, however, now using our lifelong limb salvage calculation we know they actually had an 88 percent chance of living out their lives with the affected limb intact.”
The researchers at BIDMC recently reviewed seven years of records for patients who experienced a first-time surgical intervention for one of the three symptoms. Here is how likely patients with each symptom were to keep their limbs:
- Resting leg pain – 91 percent
- Ulcer – 86 percent
- Gangrene – 78 percent
Shean and fellow researcher Dr. Peter A. Soden, will present the findings of the study, “Lifelong Limb Salvage: A Patient-Centered Description of Lower Extremity Arterial Reconstruction Outcomes,” at the Society for Vascular Surgery’s Vascular Annual Meeting in June near Washington, D.C.
“We tell patients, ‘We can now tell with more certainty the likelihood that you will keep your limb, and that plays a major role in your quality of life and how long you will live,'” said Shean.
Critical limb ischemia is found in at least 12 percent of U.S. adults, according to data in the National Institutes of Health online resources. Patients in this specific population are at high risk of death from stroke or heart attack.
LoGerfo finds the new way of calculating risk to be encouraging for his patients. Previously he could tell them what their 10-year chances were, but, “I had no precise measure of that outcome. I knew I was not seeing 50 percent of my patients returning for amputation. Over the years that prompted me to look for a new way to measure their outcomes.”
Vascular surgeons are the only surgical specialty trained in all aspects of vascular care and surgical options. All people over 50 should have regular annual physicals and increase awareness of their vascular health. – PRNewswire