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Expected Outcomes In Patients With CLTI Following Revascularization With Complete Follow Up
Andrew A. Droney, MD, Mariel Rivero, MD, Brittany Montross, MD, Sikandar Khan, MBBS, Linda Harris, MD, Maciej Drjski, MD, Hasan H. Dosluoglu, MD.
SUNY at Buffalo, Buffalo, NY, USA.
Objectives: Patients with chronic limb threatening ischemia (CLTI) are known to have a reduced life expectancy, and revascularization is chosen based on anatomic features as well as expected survival. However, the natural history of patients who have undergone revascularization based on a real-world, individualized approach to appropriate case and procedure selection has not been reported. The goal of this study is to assess the survival, amputation-free survival (AFS), MALE/Mortality-free survival following individualized revascularization in patients with CLTI with complete follow up and identify patients who are likely to survive longer.
Methods: All consecutive patients who had revascularization for CLTI between 1/2003-8/2020 for CLTI were included. Only the index limbs were included. All patients had complete follow up for at least 48 months or until death. In addition, patients who died within 0-47 months (Group I, N=479) were compared to those who died or were followed for 48-71 months (Group II, N=146) and 72-120 months (Group III, N=256).
Results: A total of 881 patients were included, with 52.7±47.4 mo (range 0-245mo) follow-up. The 1mo, 48mo, 72mo and 120mo overall survival were 96.7%, 45±2%, 31±2% and 14±1%; AFS 95.1%, 39±2%, 27±2% and 13±1%; MALE/mortality-free survival 93.5%, 32±2%, 21±1% and 11±1%; Limb salvage 98.4%, 84±1%, 83±2% and 79±2% . Group II and III were younger, less likely to have CAD, DM, CKD, ESRD, CVD, and were more likely to be ambulatory compared to Group I (Table). Statin use was similar in Groups I and III, and higher in Group II, and Group III had more open revascularizations than other groups (P=0.035 III vs I and II). During last follow up, patients in Group I were less likely to have intact skin without an amputation (58.2%vs76.0%vs76.6%(P<0.001)).
Conclusions: Patients with CLTI represent a highly challenging group with over half expected to die within 4 years, however the other half will survive up to 10 years or more. Younger patients, despite higher smoking rates, have the potential for significant long-term survival and therefore merit consideration for more aggressive treatment.
Comorbidiities and clinical characteristics in Groups | Group I (N=479) | Group II (N=146) | Group III (N=256) | |
| Age | 75.0±10.1 | 70.7±9.3 | 65.5±9.4 | <0.001 |
| CAD | 67% | 59% | 39% | <0.001 |
| DM | 63% | 58% | 50% | 0.004 |
| CKD/ESRD | 45/11% | 44/1% | 17/0.3% | <0.001 |
| Beta-blocker | 62% | 58% | 52% | 0.002 |
| Statin | 58% | 68% | 57% | 0.053 |
| Active smoker | 25% | 33% | 52% | <0.001 |
| Ambulatory | 71% | 88% | 91% | <0.001 |
| Open revasc | 22% | 24% | 29% | 0.035, III vs I and II |
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