IngentaConnect Critical Limb Ischemia and Diabetes: Creative Limb Salvage Revasc...

Authors: Allie, David E.; Patlola, Raghotham R.; Herbert, Chris J.; Walker, Craig M.

Source: Journal for Vascular Ultrasound, Volume 32, Number 1, March 2008 , pp. 27-33(7)

Publisher: Society for Vascular Ultrasound

Abstract:

Critical limb ischemia (CLI) and diabetes mellitus (DM) are implicated in the majority of all lower-extremity amputations. Sparse data exist on the true prevalence of CLI, but in the United States, it is estimated at 1% of the population that is >50 years of age, at least double that incidence in the >70 years age group, and the incidence of CLI is expected to increase significantly with our aging population and expected increase in diabetes. Since 1985, the U.S. amputation rate has increased from 19 to 30 per 100,000 persons years in the general population with a sobering 4- to 5-fold increase in the >80 years age group to 140 per 100,000 persons years. An analysis of the most recent U.S. and European data on the number of amputations performed yearly estimates 160,000-180,000 per year in the United States with an estimated 10% yearly increase and 40,000-50,000 yearly in Europe for a combined estimate of >220,000-240,000 amputations yearly. It is estimated that 80% of all amputations are preceded by a diabetic foot ulcer (DFU) and that most DFUs are preventable. Still, worldwide there is an amputation in a diabetic every 30 seconds therefore underscoring the association of DFU and CLI.

Within 1 year of being diagnosed with CLI, 40-50% of the now 21 million U.S. diabetics will experience a major amputation and 30-40% death. Moreover, 30-50% of diabetic amputees will face contralateral CLI and undergo a second limb (contralateral) amputation within 3-5 years of ipsilateral amputation. It has been estimated that the total cost of treating CLI in the United States alone is $10-20 billion per year and that just a 25% reduction in amputations could save the U.S. healthcare system $2.9-3.0 billion yearly.

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Critical Limb Ischemia and Diabetes: Creative Limb Salvage Revascularization Strategies