Outcomes in Patients with Critical Limb Ischemia due to Arteriosclerosis Obliterans Who Did Not Undergo Arterial Reconstruction

Int Heart J. 2018 Sep 26;59(5):1041-1046. doi: 10.1536/ihj.17-592. Epub 2018 Aug 11.


The prevalence of arteriosclerosis obliterans (ASO) and critical limb ischemia (CLI) is currently increasing, and arterial reconstruction is often attempted to salvage the limb. Some patients cannot undergo attempted revascularization because of contraindications, and they only receive conservative treatment. In this study, we investigate the comorbidities and survival rates of patients with CLI who receive conservative treatment. Thirty-five patients with CLI due to ASO, who had not undergone revascularization surgery (C group), were enrolled. As controls, 136 patients with CLI due to ASO who did undergo revascularization (R group), mainly via bypass surgery, were enrolled. Coronary artery disease, heart failure, and respiratory dysfunction were factors indicating conservative treatment. Limb salvage rates and survival rates were not significantly different between the two groups. Patients who had survived for less than two years after surgery had a higher prevalence of chronic heart failure, cardiovascular disease, and end-stage renal disease compared to patients who had survived for more than two years. The use of statins, dual antiplatelets, aspirin, or warfarin did not influence whether a patient survived for longer than two years. 77% of patients survived for more than two years after receiving only conservative therapies. Surgical revascularization did not improve the prognosis of patients with CLI as compared with the conservative therapy. Clinicians might start with conservative treatment while considering other treatment options for patients with CLI.

Keywords: Comorbidities; Conservative treatment; Drug therapy; Limb salvage; Peripheral artery disease; Revascularization; Survival.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arteriosclerosis Obliterans / complications
  • Arteriosclerosis Obliterans / epidemiology*
  • Cardiovascular Diseases / epidemiology
  • Comorbidity
  • Conservative Treatment / methods*
  • Conservative Treatment / statistics & numerical data
  • Female
  • Heart Failure / epidemiology
  • Humans
  • Ischemia / pathology
  • Kidney Failure, Chronic / epidemiology
  • Limb Salvage / methods*
  • Lower Extremity / blood supply
  • Lower Extremity / pathology*
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / drug therapy
  • Peripheral Arterial Disease / pathology*
  • Peripheral Arterial Disease / surgery
  • Prevalence
  • Treatment Outcome