Conservative Regimen for Chronic Critical Limb Ischemia
WAIGOON STAPANAV ATR, MD*, WITHOON UNGKITTPAIBOON, MD*, BURAPA KARNJANABATR,MD*
Affiliation : * Department of Surgery, Vajira Hospital, Bangkok Metropolitans Administration Medical School, Bangkok 10330, Thailand. '
Objective : The objective of this study was to determine the effectiveness of the treatment of chronic critical limb ischemia by conservative regimen.
Method : Data for all patients who underwent a conservative regimen at a single institution from January 1997 to December 2001 were entered into the registry. Conservative regimen consisted of cilostazol (Pletaal) 200 mg/day, a vegetarian diet, had completely stopped smoking and had progres sive walking training.
Results : A total of 53 patients (59 limbs) with chronic critical limb ischemia were treated with a conservative regimen. The conservative regimen failed in 19limbs (32.2%). In the failed limbs, infra inguinal bypass was performed on 8 limbs, aortoiliac endarterectomy was performed on 1 limb and 6 had primary amputation. The other four limbs were treated conservatively until death because of very poor cardiac function. Post-operatively, 2 grafts had thrombosis and led to amputation.
Conclusion : These early results appear to be promising with 67.8 per cent limb saving. This conservative regimen may be appropriately performed in selected chronic critical limb ischemia, especially those who presented with clinical severe claudication, rest pain or nonhealed ulcer. Cilostazol administration may play a positive role in gangrenous limbs.
Keywords : Conservative Regimen, Critical Limb Ischemia, Cilostazol
