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Factors associated with all-cause mortality in endovascularly treated patients with chronic limb-threatening ischemia

Mária Rašiová¹, Veronika Pavlíková¹, Marek Hudák¹

¹Faculty of Medicine, Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Šafárik University, Košice, Slovakia.

Frontiers in Epidemiology

|February 9, 2026

Insights

High 5-year mortality in chronic limb-threatening ischemia (CLTI) patients undergoing endovascular treatment (EVT) is linked to female sex, extensive treatment, and elevated creatinine/fibrinogen. Reintervention and amputation after EVT were associated with lower mortality.

Area of Science:

Vascular Surgery
Cardiology
Endovascular Interventions

Background:

Chronic limb-threatening ischemia (CLTI) presents a significant mortality risk despite therapeutic advancements.
Foot ischemic ulcers in CLTI patients pose a particular challenge for treatment and prognosis.

Purpose of the Study:

To assess the 5-year all-cause mortality rate in patients with CLTI and foot ischemic ulcers who underwent endovascular treatment (EVT).
To identify factors associated with increased or decreased mortality risk in this patient cohort.

Main Methods:

Retrospective analysis of 451 patients undergoing EVT for lower extremity peripheral artery disease (2016-2018).
Multivariate analysis adjusted for numerous clinical and procedural variables, including sex, comorbidities, reintervention, and amputation.
Evaluation of 5-year all-cause mortality as the primary outcome.

Main Results:

The 5-year all-cause mortality rate was 60.5%.
Higher mortality risk was associated with female sex, EVT in multiple regions, elevated creatinine, and higher fibrinogen levels.
Lower mortality risk was observed with ipsilateral reintervention and ipsilateral amputation post-EVT.

Conclusions:

Female sex, extensive EVT, and elevated creatinine/fibrinogen are independent predictors of higher 5-year mortality in CLTI patients.
Ipsilateral reintervention and amputation following EVT may be associated with a reduced risk of all-cause mortality.

Read full analysis

Abstract

Background:

Despite advances in treatment, mortality in patients with chronic limb-threatening ischemia (CLTI) is high. The aim of our study was to evaluate 5-year all-cause mortality and factors associated with it in endovascularly treated (EVT) patients with foot ischemic ulcers.

Methods:

We reviewed all patients who had undergone EVT for lower extremity peripheral artery disease between January 2016 and December 2018. Adjustments in multivariate analyses were performed for age, hypertension, diabetes mellitus, sex, smoking, dyslipidemia, chronic obstructive pulmonary disease, malignancy, atrial fibrillation, heart failure with reduced ejection fraction, coronary artery disease, postprocedural ipsilateral amputation, ipsilateral reintervention, number of endovascularly treated regions, fibrinogen and creatinine.

Results:

Four hundred and fifty-one patients (155 women, 296 men) with a mean age of 70.4 ± 9.60 years were included in the analysis. The 5-year all-cause mortality was 60.5%. In multivariate analysis mortality risk was higher in women (HR 1.42; 95% CI 1.09-1.86; p = 0.010), and after EVT in two or more anatomical regions (HR 1.37; 95% CI 1.05-1.79; p = 0.022). The mortality risk was positively associated with creatinine (HR 1.003; 95% CI 1.002-1.004; p < 0.001), and fibrinogen (HR 1.19; 95% CI 1.11-1.29; p < 0.001). Ipsilateral reintervention (HR 0.67; 95%CI 0.47-0.94; p = 0.021) and ipsilateral amputation after EVT (HR 0.71; 95% CI 0.51-0.98; p = 0.037) were associated with lower all-cause mortality risk.

Conclusions:

Female sex, treatment in two or more anatomical regions, creatinine and fibrinogen were associated with higher 5-year mortality risk. Lower 5-year all-cause mortality risk was observed in patients with ipsilateral reintervention and ipsilateral amputation after EVT.

Keywords:

amputation creatinine ischemia mortality reintervention

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