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Updated: Jan 2, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Outcome of patients with chronic limb-threatening ischemia with and without revascularization
Jacqueline Stella1, Christiane Engelbertz1, Katrin Gebauer1
1Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Münster, Germany.
Insights
Revascularization in chronic critical limb-threatening ischemia (CLTI) patients significantly reduced amputation and death rates in a real-world study. However, only half of CLTI patients received this treatment, highlighting a gap in care.
Area of Science:
- Vascular Surgery
- Health Services Research
- Epidemiology
Background:
- Chronic critical limb-threatening ischemia (CLTI) poses a high risk of amputation and mortality.
- Existing guidelines recommend revascularization for CLTI, but robust evidence is limited.
- Real-world data are needed to evaluate the outcomes of CLTI treatment strategies.
Purpose of the Study:
- To assess the impact of revascularization on limb amputation and mortality in CLTI patients.
- To analyze outcomes based on whether revascularization was performed during index hospitalization.
- To evaluate real-world treatment patterns and outcomes for CLTI patients.
Main Methods:
- Retrospective cohort study using administrative data from a large German health insurance (BARMER GEK).
- Inclusion of patients hospitalized for CLTI Rutherford categories 5 and 6 between 2009-2011.
- Follow-up until December 31, 2012, to record limb amputations and all-cause mortality, comparing revascularized (Rx+) versus non-revascularized (Rx-) groups.
Main Results:
- 15,314 CLTI patients were identified; 50% underwent revascularization (Rx+), 50% received conservative treatment (Rx-).
- Limb amputation rates were significantly lower in the Rx+ group (40.6%) compared to the Rx- group (46.5%).
- Overall mortality was also significantly lower in the Rx+ group (42.6%) versus the Rx- group (48.2%).
Conclusions:
- Revascularization in CLTI patients is associated with significantly better short- and long-term outcomes in a real-world setting.
- Only half of CLTI patients received revascularization during inpatient treatment, indicating potential undertreatment.
- Causal conclusions are limited due to potential selection bias inherent in observational data.
Abstract:
Background: Patients with chronic critical limb-threatening ischemia (CLTI) are at high risk of amputation and death. Despite the general recommendation for revascularization in CTLI in the guidelines, the underlying evidence for such a recommendation is limited. The aim of our study was to assess the outcome of patients with CLTI depending on the use of revascularization in a retrospective real-world cohort. Patients and methods: Administrative data of the largest German Health insurance (BARMER GEK) were provided for all patients that were hospitalized for the treatment of CLTI Rutherford category (RF) 5 and 6 between 2009 and 2011. Patients were followed-up until December 31st, 2012 for limb amputation and death in relation to whether patients did (Rx +) or did not have (Rx -) revascularization during index-hospitalization. Results: We identified 15,314 patients with CLTI at RF5 (n = 6,908 (45.1%)) and RF6 (n = 8,406 (54.9%)), thereof 7,651 (50.0%) underwent revascularization (Rx +) and 7,663 (50.0%) were treated conservatively (Rx -). During follow-up (mean 647 days; 95% CI 640-654 days) limb amputation (46.5% Rx- vs. 40.6% Rx+, P < 0.001) and overall mortality (48.2% Rx- vs. 42.6% Rx+, P < 0.001) were significantly lower in the subgroup Rx+. Conclusions: In a real-world setting, only half of CLTI were revascularized during the in-hospital treatment. Though, revascularization was associated with significantly better observed short- and long-term outcome. These data do not allow causal conclusion due to lack of data on the underlying reason for applied or withheld revascularization and therefore may involve a relevant selection bias.
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