Predictors of failure of endovascular revascularization for critical limb ischemia

Background and Aims: To characterize predictors of failure when treating critical limb ischemia (CLI) patients with an endovascular intervention as the first-line strategy.Patients and Methods: This retrospective, registry-based study included 217 consecutive pa-tients with 240 chronic critically ischemic limbs treated with infrainguinal percutaneous trans-luminal angioplasty (PTA) during 2006-2007 at Helsinki University Central Hospital, Finland.The primary outcome measures were death, major (above-ankle) amputation, and the need for surgical re-intervention within 6 months after the primary procedure. The secondary out-come measures were overall major amputation and survival rates as well as the overall need for surgical or any other (surgical or endovascular) type of re-intervention.Predictors of outcome endpoints were identified with a univariate screen, and a Cox regres-sion model was used in the multivariate analysis.Results: Compared to ulcer, gangrene was significantly more strongly associated with ampu-tation within 6 months post-procedurally as well as during the whole follow-up period (p?≤?0.028). The patient's inability to walk upon hospital arrival was a significant predictor of death, amputation and surgical re-intervention.Mediasclerotic ankle-brachial index (ABI) was an independent predictor of amputation as well as endovascular re-interventions.Conclusions: The strong predictors of poor outcome after endovascular revascularization for patients with CLI are cardiac morbidity, the inability to ambulate upon hospital arrival, and gangrene as a manifestation of CLI. The risk of amputation seems to be significantly higher for gangrene than for ulcer and this matter should be taken into account in the clinical classifica-tions for CLI.