Trends in Characteristics and Treatment of Patients With Chronic Limb-Threatening Ischemia Undergoing Endovascular Therapy

Background

Due to an aging population and the growing prevalence of diabetes, patients with chronic limb-threatening ischemia (CLTI) represent a growing burden on health care and social services.

Objectives

This study aimed to investigate the trends in characteristics and treatment of patients with CLTI.

Methods

This multicenter retrospective study included 2,085 patients with CLTI who underwent endovascular therapy between April 2010 and March 2023. Clinical characteristics and outcomes were compared among 4 groups based on treatment period quartiles (Q1-Q4). The clinical characteristics of the patients, limbs, and anatomical severity were assessed according to the global vascular guidelines. The outcome measures were mortality or major amputation rate, and reintervention rate.

Results

The median follow-up period was 14.9 months (IQR: 3.9-36.5 months). In the later periods, patient risk was higher, wound severity was lower, and anatomical severity was higher in inframalleolar lesions (each P < 0.05). The mortality or major amputation rate at 1 year did not significantly differ across Q1-Q4 (24.2% [95% CI: 20.5%-28.5%], 22.7% [95% CI: 19.0%-27.0%], 25.6% [95% CI: 21.8%-30.0%], and 28.9% [95% CI: 24.7%-33.5%] in Q1-Q4, respectively; P for trend = 0.18). The reintervention rate at 1 year was significantly lower in the later periods (43.2% [95% CI: 38.5%-48.3%], 45.2% [95% CI: 40.4%-50.4%], 37.8% [95% CI: 33.2%-42.8%], and 32.5% [95% CI: 27.9%-37.6%] in Q1-Q4, respectively; P for trend = 0.002).

Conclusions

The characteristics of patients with CLTI were significantly different across the treatment period. The mortality or major amputation rates did not significantly different, whereas the reintervention rate was significantly lower in the later periods.