The impact of prolonged lower limb ischemia on amputation, mortality, and functional status: The FRIENDS registry

Sue Duval, Hong H. Keo, Niki C. Oldenburg, Iris Baumgartner, Michael R. Jaff, James M. Peacock, Alexander S. Tretinyak, Timothy D Henry, Russell V Luepker, Alan T. Hirsch

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background Peripheral artery disease (PAD) is a major cause of cardiovascular ischemic events and amputation. Knowledge gaps exist in defining and measuring key factors that predict these events. The objective of this study was to assess whether duration of limb ischemia would serve as a major predictor of limb and patient survival. Methods The FReedom from Ischemic Events: New Dimensions for Survival (FRIENDS) registry enrolled consecutive patients with limb-threatening peripheral artery disease at a single tertiary care hospital. Demographic information, key clinical care time segments, functional status and use of revascularization, and pharmacotherapy data were collected at baseline, and vascular ischemic events, cardiovascular mortality, and all-cause mortality were recorded at 30 days and 1 year. Results A total of 200 patients with median (interquartile range) age of 76 years (65-84 years) were enrolled in the registry. Median duration of limb ischemia was 0.75 days for acute limb ischemia (ALI) and 61 days for chronic critical limb ischemia (CLI). Duration of limb ischemia of <12, 12 to 24, and >24 hours in patients with ALI was associated with much higher rates of first amputation (P =.0002) and worse amputation-free survival (P =.037). No such associations were observed in patients with CLI. Conclusions For individuals with ischemic symptoms <14 days, prolonged limb ischemia is associated with higher 30-day and 1-year amputation, systemic ischemic event rates, and worse amputation-free survival. No such associations are evident for individuals with chronic CLI. These data imply that prompt diagnosis and revascularization might improve outcomes for patients with ALI.

Original languageEnglish (US)
Pages (from-to)577-587
Number of pages11
JournalAmerican Heart Journal
Issue number4
StatePublished - Oct 1 2014

Bibliographical note

Funding Information:
Financial Support: Dr Keo received a fellowship grant (PBBEB-121067) from the Swiss National Science Foundation and an investigator-initiated research grant from Abbott Vascular, Switzerland. Additional support for registry development was provided via an investigator-initiated grant to the University of Minnesota (Dr Hirsch) from Abbott Vascular, USA, and by contributions from the Minneapolis Heart Institute Foundation at the Abbott Northwestern Hospital, Minneapolis, MN, USA.

Publisher Copyright:
© 2014 Mosby, Inc.


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