Vaskulárna medicína 1/2026
Mortality in patients with chronic limb threatening ischemia
Introduction: Mortality among patients with chronic limb-threatening ischemia (CLTI) remains high despite advances in treatment. The aim of this study was to evaluate 5-year all-cause mortality and its associated factors in patients with ischemic foot wounds following endovascular treatment.
Material and methods: Patients with CLTI and ischemic foot wounds who underwent their first endovascular treatment (EVT) on the affected limb at our institution between 2016 and 2018 were retrospectively analyzed. Mortality, reinterventions, and amputations were monitored after the intervention. The impact of demographic and angiographic factors, comorbidities, treatments and laboratory parameters on 5-year mortality was evaluated.
Results: A total of 451 patients (155 women, 296 men; mean age 70.4 years, SD 9.60) were included. Overall 5-year mortality was 60.5%. In the multivariate model, mortality was positively associated with older age (HR 1.04; 95% CI 1.03–1.06; p=0.001), female sex (HR 1.43; 95% CI 1.10–1.85; p=0.007), chronic obstructive pulmonary disease (COPD) (HR 1.71; 95% CI 1.14–2.58; p=0.010), heart failure with reduced ejection fraction (HFrEF) (HR 1.54; 95% CI 1.08–2.21; p=0.017), EVT in 2–3 anatomic regions (HR 1.34; 95% CI 1.03–1.59; p=0.028), creatinine (HR 1.003; 95% CI 1.002–1.004; p=0.001) and fibrinogen (HR 1.19; 95% CI 1.10–1.28; p=0.001). Mortality was negatively associated with ipsilateral reintervention (HR 0.60; 95% CI 0.43–0.82; p=0.002), amputation after endovascular treatment (HR 0.63; 95% CI 0.47–0.86; p=0.004), and use of angiotensin- converting enzyme inhibitors (ACE inhibitors)/ARBs (HR 0.73; 95% CI 0.55–0.98; p=0.039).
Conclusion: Female sex, advanced age, COPD, HFrEF, multilevel (2–3 region) EVT, elevated creatinine and fibrinogen were associated with a higher risk of 5-year mortality. Lower 5-year mortality was observed in patients with ipsilateral reintervention, amputation after endovascular therapy and those treated with ACE inhibitors/ARBs.
Keywords: mortality, CLTI, endovascular treatment, amputation, reintervention, creatinine, fibrinogen
