Risk factors for major leg amputation in patients treated endovascularly due to critical limb ischaemia

Abstract

Introduction. Critical limb ischaemia (CLI) is an advanced phase of chronic lower extremity ischaemia linked to increased mortality, decreased quality of life, and the risk of leg amputation. The aim of this study was to determine factors affecting the risk of leg amputation among patients with CLI treated endovascularly as a first approach.

Material and methods. Of 118 patients treated endovascularly, 32 (27%) had a leg amputated. Their clinical data were analysed retrospectively.

Results. Patients who had a leg amputated initially had a higher Rutherford class, were older, and had a greater prevalence of comorbidities. In multivariate analysis, amputation-free survival was shortened by a history of dyslipidaemia, female gender, blood creatinine concentration, the need for target lesion revascularization, smoking habit, Rutherford class, and leukocyte blood count. Whereas, the factors which decreased the risk of leg amputation were: use of statins, the number of previous interventions, and blood LDL cholesterol concentration. Angiographic classification of lesion severity did not affect endovascular procedure outcome.

Conclusions. The risk of major amputation following endovascular treatment in patients with CLI was associated with a number of characteristics, mainly: atherosclerosis risk factors and necrosis advancement, and the number of reinterventions. To avoid endangering patients and the unnecessary utilization of resources, it would seem to be worth performing large studies to determine a risk stratification scoring system for patients with CLI, which could enable the qualification of risk-adjusted patients for endovascular or surgical revascularization or for primary leg amputation.