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Trends in Characteristics and Treatment of Patients With Chronic Limb-Threatening Ischemia Undergoing Endovascular
Yosuke Hata1, Osamu Iida2, Sho Nakao1
1Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
Insights
Trends in chronic limb-threatening ischemia (CLTI) show evolving patient risk and anatomical severity. While mortality/major amputation rates remained stable, endovascular therapy led to significantly lower reintervention rates in later treatment periods.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Public Health
Background:
- Chronic limb-threatening ischemia (CLTI) poses a growing healthcare challenge due to an aging population and increased diabetes prevalence.
- Patients with CLTI represent a significant and increasing burden on healthcare and social services.
Purpose of the Study:
- To investigate temporal trends in patient characteristics and treatment outcomes for CLTI.
- To analyze changes in clinical presentation, lesion severity, and therapeutic approaches over time.
Main Methods:
- A multicenter retrospective study of 2,085 patients with CLTI undergoing endovascular therapy from April 2010 to March 2023.
- Patients were stratified into four quartiles based on treatment period (Q1-Q4) to compare characteristics and outcomes.
- Outcomes assessed included mortality, major amputation rates, and reintervention rates, analyzed against global vascular guidelines.
Main Results:
- Later treatment periods showed higher patient risk and anatomical severity, particularly in inframalleolar lesions, though wound severity decreased.
- One-year mortality or major amputation rates did not significantly differ across the four quartiles (P=0.18).
- A significant decrease in the one-year reintervention rate was observed in later treatment periods (P=0.002).
Conclusions:
- Patient characteristics for CLTI have evolved over the study period.
- Endovascular therapy for CLTI has not significantly altered mortality or major amputation rates.
- Later treatment periods demonstrated a significant reduction in reintervention rates for CLTI patients.
Background:
Due to an aging population and the growing prevalence of diabetes, patients with chronic limb-threatening ischemia (CLTI) represent a growing burden on health care and social services.
Objectives:
This study aimed to investigate the trends in characteristics and treatment of patients with CLTI.
Methods:
This multicenter retrospective study included 2,085 patients with CLTI who underwent endovascular therapy between April 2010 and March 2023. Clinical characteristics and outcomes were compared among 4 groups based on treatment period quartiles (Q1-Q4). The clinical characteristics of the patients, limbs, and anatomical severity were assessed according to the global vascular guidelines. The outcome measures were mortality or major amputation rate, and reintervention rate.
Results:
The median follow-up period was 14.9 months (IQR: 3.9-36.5 months). In the later periods, patient risk was higher, wound severity was lower, and anatomical severity was higher in inframalleolar lesions (each P < 0.05). The mortality or major amputation rate at 1 year did not significantly differ across Q1-Q4 (24.2% [95% CI: 20.5%-28.5%], 22.7% [95% CI: 19.0%-27.0%], 25.6% [95% CI: 21.8%-30.0%], and 28.9% [95% CI: 24.7%-33.5%] in Q1-Q4, respectively; P for trend = 0.18). The reintervention rate at 1 year was significantly lower in the later periods (43.2% [95% CI: 38.5%-48.3%], 45.2% [95% CI: 40.4%-50.4%], 37.8% [95% CI: 33.2%-42.8%], and 32.5% [95% CI: 27.9%-37.6%] in Q1-Q4, respectively; P for trend = 0.002).
Conclusions:
The characteristics of patients with CLTI were significantly different across the treatment period. The mortality or major amputation rates did not significantly different, whereas the reintervention rate was significantly lower in the later periods.
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