Exploring the management of patients with chronic limb threatening ischaemia due to infra-popliteal disease

Popplewell, Matthew Adam (2022). Exploring the management of patients with chronic limb threatening ischaemia due to infra-popliteal disease. University of Birmingham. M.D.

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Abstract

Introduction
The incidence of chronic limb threatening ischaemia (CLTI) secondary to infra-popliteal (IP) disease is increasing. Despite this, the current evidence base supporting clinical management decisions is poor.
Methods & Aims
To use the vehicle of the Bypass versus Angioplasty in Severe Ischaemia of the Leg 1 and 2 (BASIL-1 and 2) randomised controlled trials to provide new evidence to help inform treatment decisions for patients presenting with CLTI secondary to IP disease.
Results
Both the IP subgroup analysis of BASIL-1 and retrospective analyses of data from our own institution revealed that vein bypass was associated improved overall survival, although patients experienced higher rates of morbidity and longer in hospital stays than those undergoing endovascular treatment. Although immediate technical outcomes have improved in endovascular treatment since BASIL-1, overall survival and limb salvage have not. IP vein bypass and major amputation are more expensive in terms of human resources and in-patient costs. The overall survival of patients with untreated CLTI is poor at around 50% at 1 year.
Conclusions
Evidence from this thesis suggests that IP endovascular treatment should likely be reserved for those who are not suitable for vein bypass, however further randomised trials and a large, concerted, public health effort are required to confirm this and achieve improved outcomes in this challenging patient group.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):