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Outcomes of Endovascular Treatment for Critical Limb Threatening Ischemia

Adam Beucler1, Elias Wheibe2, Sagar S Gandhi2

  • 1Department of Vascular Surgery/Medicine, Prisma Health System, Greenville, SC.

Annals of Vascular Surgery
|November 3, 2023
PubMed

Insights

Endovascular therapy for critical limb threatening ischemia (CLTI) with ulceration shows high risks for amputation and mortality. Vigilant infection management is crucial for amputation prevention in CLTI patients.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Wound Care

Background:

  • Critical limb threatening ischemia (CLTI) with ischemic ulceration is linked to high morbidity and mortality.
  • Endovascular therapy has been the primary treatment, but its efficacy is under review following the BEST-CLI trial.
  • This study evaluates outcomes of endovascular-first treatment in CLTI patients with ischemic ulceration.

Purpose of the Study:

  • To assess the outcomes of endovascular-first therapy in patients with critical limb threatening ischemia and ischemic ulceration.
  • To identify predictors of mortality and amputation-free survival in this patient cohort.
  • To compare findings with the Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Threatening Ischemia (BEST-CLI) trial.

Main Methods:

  • Retrospective evaluation of 150 CLTI patients with ischemic ulceration treated with endovascular-first therapy.
  • Analysis of patient demographics, co-morbidities, and anatomic severity using Society for Vascular Surgery criteria (Global Limb Anatomical Staging System).
  • Kaplan-Meier survival analysis and logistic regression to identify predictors of mortality and amputation-free survival.

Main Results:

  • The study included 150 patients (mean age 72 years), predominantly male, Caucasian, and ambulatory, with high rates of diabetes (67%) and smoking history (49%).
  • A significant proportion (64.4%) had unfavorable anatomy (Global Limb Anatomical Staging System stages 2-3) for long-term patency.
  • At 24 months, survival was 69%, amputation-free survival was 38%, and reintervention rates were 36%. Infection was a significant predictor of mortality and reduced amputation-free survival.

Conclusions:

  • Endovascular treatment for CLTI with ischemic ulceration, even when technically successful, is associated with substantial risks of limb loss and mortality.
  • Effective amputation prevention strategies must prioritize the management of infection.
  • These findings support the applicability of patient-centered care informed by data from trials like BEST-CLI.
Abstract

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