Predictive factors of a poor outcome following revascularization for critical limb ischemia: implications for practice

Int Angiol . 2018 Oct;37(5):370-376. doi: 10.23736/S0392-9590.18.03986-X. Epub 2018 May 23

Fecha de la publicación: 23/05/2018

Autor: Mireia Martínez (1), Claudia Sosa (2, 3), Alina Velescu (4, 3, 5), Carme Llort (4, 3), Roberto Elosua (3, 5), Albert Clarà (1, 4, 3, 5)


1Autonomous University of Barcelona, Bellaterra, Barcelona, Spain.

2Department of Vascular Surgery, Hospital del Mar, Barcelona, Spain –

3Cardiovascular Epidemiology and Genetics, IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.

4Department of Vascular Surgery, Hospital del Mar, Barcelona, Spain.

5CIBER Cardiovascular, Barcelona, Spain.


Background: Advancements in open and endovascular techniques have brought a widespread indication of revascularization in the majority of patients with critical limb ischemia (CLI). However, some cases still have a dismal short-term outcome. Identifying preoperative variables that characterize these patients could be important to prevent futile decisions. The aim of this study was to define predictive risk factors of mortality and/or major amputation after revascularization for CLI.

Methods: Retrospective study of 515 consecutive patients (mean age=73 years; 73% males) undergoing open (N.=228; 44.3%) or endovascular (N.=287; 55.7%) surgery for CLI between 2005 and 2015. Neither redo-procedures (ipsilateral or contralateral) nor acute limb ischemia patients were included as new cases.

Results: Thirty-day amputation, mortality or combined event rates were 1.4% (N.=7), 4.5% (N.=23) and 5.6% (N.=29), while at 90 days were 4.1 (N.=21), 9.1% (N.=47) and 12.8% (N.=66), respectively. We found no significant differences between open or endovascular surgery. Risk factors associated with a 90-day combined event were age (OR=1.04, P=0.014), preoperative hemoglobin (OR=0.80; P=0.003), history of acute myocardial infarction (OR=2.68; P=0.007), ischemic ulcers (OR=2.57; P=0.014) and below-the-knee revascularization (OR=2.20; P=0.007). The discrimination of the model was good (area under ROC curve=0.75). Model predicted probabilities of the combined death and/or lower limb major amputation end-point ranged (95% interval) from 1.1% to 38.1%.

Conclusions: Certain preoperative variables can predict satisfactorily the short-term outcome after revascularization for CLI, although they are not sufficiently useful to identify the patient in whom revascularization can be clearly futile. Further research is needed to refine a predictive model suitable for decision-making.