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The Role of Conservative Management in Treatment of Critical Limb Ischemia
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  • Sara Mohamed,
  • Deirdre C Mc Dermott,
  • Khalid Ahmed,
  • Veronica McInerney,
  • Linda Howard,
  • Muhammad Tubassam,
  • Timothy O'Brien,
  • STEWART WALSH
Sara Mohamed
National University of Ireland Galway
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Deirdre C Mc Dermott
National University of Ireland Galway
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Khalid Ahmed
National University of Ireland Galway
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Veronica McInerney
National University of Ireland Galway
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Linda Howard
National University of Ireland Galway
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Muhammad Tubassam
Galway University Hospitals
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Timothy O'Brien
National University of Ireland Galway
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STEWART WALSH
National University of Ireland Galway
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Abstract

Background: Revascularization has been considered the gold standard treatment for critical limb ischemia (CLI). Due to the high morbidity and mortality associated with intervention, evidence has emerged recently supporting the suitability of conservative management as a primary option to achieve amputation-free survival (AFS) in CLI patients even when revascularization is technically feasible. Methods: A prospective database of CLI patients was developed during pre-screening of patients for a phase 1 stem cell therapy clinical trial. The overall survival (OS) and AFS rates for patients treated with revascularization were compared to those treated conservatively. Statistical significance was set as p value < 0.05. OS and AFS for the two groups were estimated by Kaplan-Meier survival curves. Results: Patients in the conservative group were more likely to have Rutherford Class 5 and be diabetic while they were less likely to be active smokers or have hyperlipidemia (Table 1). There were no significant differences between the two groups in mortality, amputation, overall AFS or one-year AFS rates. Kaplan-Meier cumulative OS and AFS over the 3 years follow-up period of the study demonstrated significant differences between the conservative and revascularization groups (Log Rank: 0.031 & 0.045; respectively). This statistical significance was not detected when one-year AFS was evaluated (Log Rank 0.096). Conclusion: Conservative management can be a suitable management option to achieve one-year AFS for some CLI patients. Further studies are needed to identify robust clinical criteria for identifying patients who will benefit from conservative management.