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New Method of Percutaneous Revascularization Treating Severe and Hard-to-Treat Chronic Limb-Threatening

Emced Khalil1

  • 1Dr. Emced Khalil Associate Professor, Trabzon Ahi Evren Cardiothoracic Surgery, Training and Education Hospital, Trabzon, Turkey.

Pakistan Journal of Medical Sciences
|June 8, 2026
PubMed

Insights

Endovascular revascularization within a multidisciplinary limb salvage program effectively treats chronic limb-threatening ischemia (CLTI). This approach significantly improves limb salvage and reduces amputation rates in advanced CLTI patients.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Peripheral Artery Disease Management

Background:

  • Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease, carrying high risks of limb loss and mortality.
  • Current management trends favor endovascular revascularization, but success hinges on multidisciplinary care.
  • Optimizing outcomes requires a structured approach beyond technical success.

Purpose of the Study:

  • To evaluate clinical and hemodynamic outcomes of endovascular revascularization in advanced CLTI patients.
  • To assess amputation-free survival (AFS) and limb preservation within a multidisciplinary limb salvage program.
  • To identify predictors of adverse AFS events.

Main Methods:

  • Retrospective single-center study of 79 consecutive advanced CLTI patients undergoing endovascular revascularization (2019-2023).
  • Standardized medical therapy and multidisciplinary postoperative care were provided.
  • Hemodynamic improvement (ankle-brachial index) and 12-month AFS (Kaplan-Meier) were assessed; Cox regression explored predictors.

Main Results:

  • Mean ankle-brachial index significantly improved from 0.61 to 0.89 (p < 0.001).
  • 12-month amputation-free survival was 89.2%; major amputation occurred in 3.8%, and overall mortality was 1.3%.
  • Diabetes mellitus and total arterial occlusion were linked to reduced AFS.

Conclusions:

  • Endovascular revascularization within a multidisciplinary limb salvage program is safe and effective for advanced CLTI.
  • This integrated strategy achieves significant hemodynamic improvement and high AFS.
  • The approach demonstrates low major limb loss rates despite complex disease.
Abstract

Keywords:
Amputation-free survivalChronic limb-threatening ischemiaEndovascular revascularizationMajor adverse limb eventsPeripheral artery diseaseQuality of life

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