New Method of Percutaneous Revascularization Treating Severe and Hard-to-Treat Chronic Limb-Threatening

Abstract

Background & Objective: Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease and is associated with high risks of limb loss and mortality. Contemporary management increasingly favors endovascular revascularization; however, optimal outcomes depend on structured multidisciplinary care in addition to technical success. This study aimed to evaluate clinical and hemodynamic outcomes of endovascular revascularization performed within a multidisciplinary limb salvage program in patients with advanced CLTI, with a focus on amputation-free survival (AFS) and limb preservation.

Methodology: This retrospective single center study included 79 consecutive patients with advanced CLTI who underwent endovascular revascularization between January 2019 and December 2023. All patients received standardized guideline-directed medical therapy and multidisciplinary postoperative care. Hemodynamic improvement was assessed by pre- and post-procedural ankle-brachial index (ABI). AFS was evaluated using Kaplan-Meier analysis at 12 months. Univariable Cox regression analysis was performed to explore predictors of adverse AFS events.

Results: Mean ABI increased significantly from 0.61 ± 0.20 preoperatively to 0.89 ± 0.23 postoperatively (paired t test, p < 0.001). Kaplan-Meier analysis demonstrated a 12-month amputation-free survival rate of 89.2% (95% CI, 82.1-96.3). Primary and secondary patency rates were 67.1% and 27.8%, respectively. Major amputation occurred in 3.8% of patients, while overall mortality was 1.3%. In univariable analysis, diabetes mellitus and total arterial occlusion were significantly associated with reduced amputation-free survival.

Conclusion: Endovascular revascularization integrated within a multidisciplinary limb salvage program is a safe and effective strategy for patients with advanced CLTI. This approach achieves significant hemodynamic improvement, high amputation-free survival, and low rates of major limb loss despite complex anatomy and severe disease burden.