Midterm Outcomes of Endovascular-First Revascularization for Multilevel Peripheral Arterial Disease With Chronic Limb-Threatening Ischemia: A Retrospective Study From Vietnam.

Abstract

Background: Peripheral arterial disease (PAD) with chronic limb-threatening ischemia (CLTI) represents advanced systemic atherosclerosis and carries high risks of amputation and mortality. Multilevel arterial involvement is common and often requires revascularization of both inflow and outflow segments. However, midterm outcome data in Vietnam remain limited.

Objectives: This study is aimed at evaluating midterm clinical outcomes and identifying factors associated with wound healing, all-cause mortality, and major limb amputation after an endovascular-first revascularization strategy for multilevel PAD with CLTI.

Methods: This retrospective case series included 91 patients with multilevel PAD (≥ 2 anatomical levels according to TASC II) and CLTI (Rutherford 4-6) treated at a tertiary hospital in Vietnam from 2017 to 2019. Patients were followed for 24 months. Kaplan-Meier analysis was used to describe survival, limb salvage, and wound healing over 24 months. Univariable and multivariable logistic regressions were used to identify factors associated with fixed-time binary outcomes within 24 months, including wound healing, mortality, and major limb amputation.

Results: The mean age was 74.0 ± 11.6 years, and 82.4% were male. The ankle-brachial index improved significantly after intervention (0.2 vs. 0.5; p < 0.001). The mean follow-up duration was 18.9 ± 8.3 months. At 24 months, mortality was 27.5%, major amputation occurred in 18.7% (limb salvage 81.3%), and 62.2% of patients with tissue loss achieved wound healing (median 5 months). Age ≥ 75 years and neutrophil-to-lymphocyte ratio ≥ 3.5 were independently associated with reduced wound healing. Wound healing was associated with lower mortality and amputation risk. Adjunctive open surgery reduced limb amputation.

Conclusion: An endovascular-first revascularization strategy for multilevel PAD with CLTI achieved acceptable midterm limb salvage and wound healing, although mortality remained considerable. Risk stratification and multimodal care are essential to improve outcomes.