Leg Ischaemia Management Collaboration

Summary

Single-centre prospective cohort study of patients presenting with severe limb ischaemia (SLI). The primary outcome measure will be 12 month major amputation rate. A historical cohort of patients identified retrospectively will be the comparitor group used to assess the impact of a newly-established rapid-access limb salvage clinic. Primary aim: \- Determine the proportion of patients with SLI undergoing major lower limb amputation within 12 months of presentation. Secondary aims: * Assess clinically important short-, medium- and long-term outcomes in those undergoing and not undergoing amputation * Prevalence and degree of frailty and cognitive impairment * Pevalence and degree of cardiac disease (detected by stress MRI) * Establish a biobank for future biomarker analysis * Investigate the role of frailty and cognitive assessments, cardiac MRI and biomarkers in risk-stratification of patients with SLI

Eligibility

PRIMARY COHORT

Inclusion Criteria:

* All patients presenting to the Leicester Vascular Institute with SLI

Exclusion Criteria:

* SLI not caused by PAOD
* Patients undergoing intervention during their index presentation prior to recruitment
* Patients lacking capacity to consent with no accompanying next of kin, relative, partner or friend who can act as a personal consulted
* Patients who cannot read, write or understand English
* Any significant disease or disorder which may either put the patient at risk because of participation in the study, or may influence the results of the study or the patient's ability to participate in the study

FRAILTY \& COGNITIVE ADDITIONAL ASSESSMENTS

Inclusion criteria:

* Patients recruited to the primary cohort in whom a decision has been made to undergo an intervention for SLI
* Patients aged ≥65 years

Exclusion criteria:

* Nil additional

CARDIAC MRI ADDITIONAL ASSESSMENTS

Inclusion criteria:

* Patients recruited to the primary cohort in whom a decision has been made to undergo an intervention

Exclusion criteria:

* Absolute contraindications to cardiac MRI (Pregnancy, Non-MR safe permanent pacemaker, implanted cardiac defibrillator, intra-auricular implant or intra-cranial clips, severe claustrophobia, unstable angina)
* Contraindication to gadolinium contrast agent (Known adverse reaction, chronic renal failure (eGFR \<30mL/min/1.73m\^2))
* Patients lacking capacity to consent for cardiac MRI

BIOMARKERS ADDITIONAL ASSESSMENTS

* Patients recruited to the primary cohort in whom a decision has been made to undergo an intervention

Exclusion criteria:

* Nil additional

Conditions6

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