Early Versus Delayed Endovascular Revascularization: Implications for Limb Salvage and Survival After Transmetatarsal...

Healing after transmetatarsal amputation (TMA) depends on adequate tissue perfusion. Revascularization prior to minor amputation improves amputation-free survival, limb preservation, and wound healing in patients with ischemic wounds. However, the optimal interval between revascularization and amputation remains unclear.

The TriNetX real-world clinical data platform was used to identify patients with chronic limb-threatening ischemia (CLTI) who underwent endovascular revascularization followed by TMA. Patients were categorized into early TMA (≤7 days after revascularization) and late TMA (8-30 days). Propensity score matching was performed using demographics, comorbidities, laboratory values, and concurrent therapies. Major amputation and all-cause mortality at 6 months and 1 year were evaluated using Cox proportional hazards models. Kaplan-Meier curves and log-rank tests were used for time-to-event analyses.

Among 700 patients with CLTI treated with revascularization before TMA, 508 underwent early TMA and 192 underwent late TMA. After matching, 185 patients remained in each group (96.3% match rate). The mean age was 66.9 ± 10.9 years, 78.1% were male, and mean follow-up was 237.2 days. At 6 months, major amputation (hazard ratio [HR], 0.87; 95% CI, 0.51-1.46; P =.597) and all-cause mortality (HR, 0.74; 95% CI, 0.45-1.20; P = .220) did not differ between groups. At 1-year, major amputation (HR, 0.87; 95% CI, 0.52-1.45; P = .599) and mortality (HR, 0.73; 95% CI, 0.46-1.14; P = .164) also remained similar. A composite endpoint of major amputation or all-cause mortality was also similar between groups (HR, 0.995; 95% CI, 0.694-1.425; P = .978).

Among patients with CLTI undergoing endovascular therapy and subsequent TMA, early (≤7 days) vs late (8-30 days) amputation timing did not significantly affect major amputation or survival outcomes.