Abstract 4368012: Regaining Ambulation as the Primary Goal in the Treatment of Chronic Limb-Threatening Ischemia

Abstract

Background: The treatment goals for chronic limb-threatening ischemia (CLTI) include limb salvage, pain control, preservation of limb function, and wound healing. Patients with CLTI are typically elderly and suffer from multiple comorbidities, leading to a poor overall prognosis. Therefore, comprehensive multidisciplinary treatment approaches are often required in addition to limb revascularization. In this study, we investigated prognostic factors in CLTI patients who underwent endovascular therapy (EVT). Methods and Results We analyzed 141 patients who underwent EVT below the popliteal artery between April 2014 and December 2018. The 1-year survival rate was 83.6%. When comparing the survival and non-survival groups at 1 year, the survival group was significantly younger (70.8 ± 11.2 vs. 76.2 ± 9.7 years, p = 0.04), had lower LDL-C levels (85.8 ± 35.2 vs. 110.3 ± 38.7 mg/dL, p = 0.02), and a higher proportion of patients were ambulatory at discharge (67.9% vs. 19.0%, p < 0.01). No significant differences were found in the presence of chronic kidney disease, ischemic heart disease, lower limb amputation, or nutritional status. Multivariate analysis identified ambulation at discharge as an independent predictor of 1-year survival. The 5-year follow-up rate was 66%, and the 5-year survival rate among followed patients was 33.3%. In the survival group, patients were younger (65.9 ± 10.5 vs. 74.1 ± 10.5 years, p < 0.01), had higher eGFR (32.4 ± 32.2 vs. 20.6 ± 20.9 mL/min/1.73m 2 , p = 0.04), higher hemoglobin levels (11.8 ± 1.7 vs. 10.7 ± 2.1 g/dL, p < 0.01), a greater proportion had good nutritional status (74.2% vs. 35.5%, p < 0.01), and a higher rate of ambulation at discharge (87.1% vs. 44.3%, p < 0.01). Multivariate analysis identified younger age, higher eGFR, better nutritional status, and ambulation at discharge as independent predictors of 5-year survival. Conclusion: The presence or absence of lower limb amputation, whether minor or major, and the length of hospital stay did not significantly affect prognosis. While advances in revascularization techniques have improved limb salvage and wound healing, our findings indicate that achieving ambulation is an even more critical determinant of long-term outcomes.