Risk factors of major adverse limb events in patients with acute limb ischemia undergoing endovascular treatment during mid-term follow-up.

Abstract

Background: Endovascular treatment is the standard practice for the management of acute limb ischemia (ALI). The risk factors affecting the clinical outcomes of endovascular intervention during mid-term follow-up remain unclear. Patients and methods: 139 patients who presented with ALI, Rutherford I - IIb, undergoing endovascular treatment from October 2016 to December 2021 were retrospectively enrolled. Baseline data, and clinical outcomes were obtained by chart reviews. Major adverse limb events (MALEs) were defined as the occurrence of all-cause mortality, any amputation, and any re-occlusion at the affected limb. All patients were monitored until the time of their death, loss of contact, the incidence of MALEs, or the end of June, 2022. Results: At median follow-up of 17 months, the prevalence of MALEs, all-cause mortality, all amputations, and all re-occlusions were 33.1%, 9.4%, 5.0%, and 24.5%. The technical success rate between catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT) groups were comparable (91.9% vs. 95.1%; p=.50). Compared with the CDT group, the PMT group exhibited a higher proportion of extensive thrombus distribution (62.7% vs. 35.1%, p<.01), while required less total urokinase dosage (x 10⁶ units) [1.20 (0.84;1.65) vs. 1.90 (1.40;2.70), p<.01] to achieve a comparable technical success rate (95.1% vs. 91.9%, p=.5). Multivariate Cox-proportional hazards analysis revealed that PMT (hazard ratio [HR] : 0.48, 95% confidence interval [CI] : 0.25-0.92; P=.03), ≧2 patent calf arteries after intervention (HR: 0.30, 95% CI: 0.10-0.97; P=.045) and Rutherford stage IIb, compared with Rutherford I and IIa, (HR: 3.51, 95% CI: 1.02-13.29; P=.047) were independently associated with MALEs. Conclusions: PMT and ≧2 patent calf arteries post-intervention are associated with lower occurrence of MALEs, while Rutherford IIb at presentation is associated with a higher risk of MALEs.