Contemporary Practice Patterns and Outcomes of Revascularization for Acute Limb Ischemia

Area of Science:

• Vascular Surgery
• Emergency Medicine
• Clinical Outcomes Research

Background:

• Acute limb ischemia (ALI) is a critical surgical emergency with significant mortality and morbidity.
• Traditional management guidelines suggest a 6-hour revascularization window, but earlier intervention may improve limb salvage.
• Current clinical practice regarding timely intervention for ALI is not well-defined.

Purpose of the Study:

• To evaluate contemporary treatment patterns and perioperative outcomes in patients with ALI.
• To assess the impact of time to surgical intervention on limb salvage and mortality.
• To identify critical time thresholds for improving outcomes in ALI patients.

Main Methods:

• Retrospective analysis of 1,015 patients undergoing open thrombectomy for ALI from March 2018 to April 2025.
• Assessment of time from symptom onset to incision and hospital arrival to incision.
• Multivariable logistic regression to correlate patient characteristics and time to surgery with 30-day and 1-year outcomes (major amputation, mortality).

Main Results:

• Major amputation rates were 7% at 30 days and 15.2% at 1 year; mortality was 2.1% at 30 days and 14% at 1 year.
• Mean hospital arrival to incision time was 7.8 hours, with 78% of patients treated >3 hours after arrival.
• Surgical intervention >6 hours after hospital arrival significantly increased the risk of major amputation at both 30 days and 1 year.

Conclusions:

• Acute limb ischemia requiring surgical thrombectomy is associated with high rates of morbidity and mortality.
• Significant delays in door-to-incision time are prevalent in ALI management.
• Optimizing door-to-incision time is a critical target for system-level interventions to enhance limb salvage and reduce adverse outcomes in ALI.