Assessing mid to long term amputation-free survival rates in chronic limb-threatening ischemia; a study of hybrid vascular techniques

Abstract

Introduction. Chronic limb-threatening ischemia (CLTI) is a debilitating condition characterized by inadequate blood supply to the lower extremities, often leading to tissue damage, ulcers, and limb loss. Amputation-free survival (AFS) serves as a crucial measure in evaluating interventions and managing CLTI, emphasizing limb preservation, functional restoration, and prevention of recurrent ischemic events. Objectives. This study aimed to assess mid to long term AFS in CLTI patients treated with hybrid vascular techniques. Materials and Methods. Conducted over 24 months at the Emergency Hospital of Saint Pantelimon in Bucharest, Romania, the study enrolled 62 adult CLTI patients, tracking them postoperatively. Kaplan Meyer survival curves were used to assess AFS rates. Results. Findings revealed a high prevalence of cardiovascular risk factors among participants, with most undergoing infrainguinal bypass revascularization in association with proximal and/or distal angioplasty with or without stenting. Prior to intervention, the majority of patients exhibited advanced stages of ischemia, with trophic lesions predominantly confined to the toes. Analysis of AFS revealed a decline over time, with the majority of amputations occurring within three months post-revascularization. Notably, 64.5% of patients achieved amputation free complete wound healing within the first year, with 90% of them achieving this within the first six months. Complex wounds were associated with prolonged healing. Conclusions. The study shows a 75.2% AFS rate at 24 months, highlighting the effectiveness of hybrid revascularization techniques and proper wound care in optimizing outcomes for CLTI patients.

Keywords

• afs
• clti
• mid-term
• long term
• wound healing