Preoperative white matter lesions and functional recovery after revascularization for chronic limb-threatening...

Restoring ambulation is an important goal of revascularization for chronic limb-threatening ischemia (CLTI), but predictors of functional recovery remain limited. We investigated whether preoperative white matter lesion (WML) burden was associated with ambulatory recovery after revascularization.

This single-center retrospective cohort included 196 patients with CLTI, tissue loss, Wound, Ischemia, and foot Infection (WIfI) ischemia grade 2 or 3, and brain magnetic resonance imaging (MRI) within 3 months before revascularization. Preoperative brain MRI was routinely obtained in patients considered for open surgical revascularization for cerebrovascular risk assessment. Periventricular and deep subcortical white matter hyperintensities were graded using the Fazekas scale; a total score of 3 or greater defined high-grade WML burden. The primary outcome was achievement of a Functional Ambulation Category score of 3 or greater within 180 days. Associations were evaluated using multivariable Cox models.

High-grade WML burden was present in 120 patients. Six-month ambulatory recovery was lower in the high-grade group than in the low-grade group (63.1% vs 82.4%; P = .019). High-grade WML burden was independently associated with slower ambulatory recovery (adjusted hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.43-0.96; P = .032) and delayed final discharge (adjusted HR, 0.63; 95% CI, 0.43-0.92; P = .017), but not with wound healing or wound-free functional limb achievement.

High-grade WML burden was associated with impaired ambulatory recovery and delayed discharge after CLTI revascularization. When preoperative brain MRI is available, WML assessment may complement limb staging and help anticipate rehabilitation and discharge needs.