One-year clinical outcomes of endovascular revascularization in patients with acute limb ischemia.

Abstract

Urgent revascularization should be performed to patients with acute limb ischemia (ALI) unless the ischemia is irreversible. In patients with severe ALI and multiple morbidities, surgical revascularization is not feasible; however, endovascular revascularization (EVR) may be an option. This study aimed to examine 1-year clinical outcomes of EVR in patients with ALI and determine prognostic factors. We retrospectively examined 90 EVR procedures performed in 81 patients with ALI between January 2018 and February 2024. The primary endpoint was 1-year amputation-free survival (AFS). Multivariable logistic regression was performed to identify predictors of 1-year AFS. Fifty-one procedures were performed for severe ALI (56.7%). Fifty-six patient were ambulatory at the time of procedures (62.2%). The 1-year AFS rate was 59.7%. Multivariable analysis revealed that hypertension (adjusted hazard ratio [aHR] 0.14; 95% confidence interval [CI], 0.05-0.47; P = 0.0007), presence of blood flow of both tibial arteries after EVR (aHR 0.19; 95% CI, 0.03-0.93; P = 0.04), and presence of arterial flow below the ankle after EVR (aHR 0.29; 95% CI, 0.09-0.84; P = 0.022) were independently associated with a higher AFS rate. Aortic plaque was independently associated with a lower AFS rate (aHR 3.98; 95% CI, 1.55-9.90; P = 0.048). EVR may be an acceptable treatment of ALI even in non-ambulatory patients and those with severe ALI. Achieving adequate blood flow of both tibial arteries and below the ankle by performing EVR may be important for improving patient outcomes.