Nonoperative active management of critical limb ischemia: Initial experience using a sequential compression biomechanical device for limb salvage

Critical limb ischemia (CLI) patients are at high risk of primary amputation. Using a sequential compression biomechanical device (SCBD) represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality. Thirty-five patients with 39 critically ischemic limbs (rest pain = 12, tissue loss = 27) presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment. The mean follow-up was 10 months (SD ± 6 months). There were four amputations, with an 18-month cumulative limb salvage rate of 88% (standard error [SE] ± 7.62%). Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mm Hg (SD ± 33.7, 95% confidence interval [Cl] 55-79). Popliteal artery flow velocity increased from 45 to 47.9 cm/s (95% Cl 35.9-59.7). Cumulative survival at 12 months was 81.2% (SE ± 11.1) for SCBD, compared with 69.2% in the control group (SE ± 12.8%) (p = .4, hazards ratio = 0.58, 95% Cl 0.15-2.32). The mean total cost of primary amputation per patient is €29,815 ($44,000) in comparison with €13,900 ($20,515) for SCBD patients. SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.