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The burden of critical limb ischemia: a review of recent literature

Authors Duff S, Mafilios MS, Bhounsule P, Hasegawa JT

Received 19 March 2019

Accepted for publication 7 June 2019

Published 1 July 2019 Volume 2019:15 Pages 187—208

DOI https://doi.org/10.2147/VHRM.S209241

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Pietro Scicchitano


Steve Duff,1 Michael S Mafilios,2 Prajakta Bhounsule,3 James T Hasegawa3

1Veritas Health Economics Consulting, Carlsbad, CA, USA; 2Health Economics Associates, San Diego, CA, USA; 3Health Economics and Reimbursement, Abbott Vascular, Santa Clara, CA, USA

Abstract: Peripheral arterial disease is a chronic vascular disease characterized by impaired circulation to the lower extremities. Its most severe stage, known as critical limb ischemia (CLI), puts patients at an increased risk of cardiovascular events, amputation, and death. The objective of this literature review is to describe the burden of disease across a comprehensive set of domains—epidemiologic, clinical, humanistic, and economic—focusing on key studies published in the last decade. CLI prevalence in the United States is estimated to be approximately 2 million and is likely to rise in the coming years given trends in important risk factors such as age, diabetes, and smoking. Hospitalization for CLI patients is common and up to 60% are readmitted within 6 months. Amputation rates are unacceptably high with a disproportionate risk for certain demographic and socioeconomic groups. In addition to limb loss, CLI patients also have reduced life expectancy with mortality typically exceeding 50% by 5 years. Given the poor clinical prognosis, it is unsurprising that the quality of life burden associated with CLI is significant. Studies assessing quality of life in CLI patients have used a variety of generic and disease-specific measures and all document a substantial impact of the disease on the patient’s physical, social, and emotional health status compared to population norms. Finally, the poor clinical outcomes and increased medical resource use lead to a considerable economic burden for national health care systems. However, published cost studies are not comprehensive and, therefore, likely underestimate the true economic impact of CLI. Our summary documents a sobering assessment of CLI burden—a poor clinical prognosis translating into diminished quality of life and high costs for millions of patients. Continued prevention efforts and improved treatment strategies are the key to ameliorating the substantial morbidity and mortality associated with this disease.

Keywords: critical limb ischemia, peripheral arterial disease, burden, amputation, quality of life, economics

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