Contemporary Practice Patterns and Outcomes of Endovascular Revascularization of Acute Limb Ischemia

BACKGROUND Acute limb ischemia is a vascular emergency associated with high rates of limb loss and mortality. As the use of endovascular techniques increases, estimation of rates and predictors of adverse outcomes remains needed. OBJECTIVES This study sought to assess contemporary outcomes and predictors of adverse events following endovascular treatment of acute limb ischemia in a nationwide, multicenter registry. METHODS Patients who had peripheral vascular intervention performed for the indication of acute limb ischemia in National Cardiovascular Data Registry Peripheral Vascular Intervention Registry between 2014 and 2020 were included. The primary outcome was a composite of all-cause mortality and major amputation during index hospitalization. Multivariable logistic regression was employed to identify predictors of the composite outcome. RESULTS There were 3,541 endovascular procedures performed during the study period. Of these, 132 (3.7%) resulted in death, and 77 (2.2%) resulted in amputation during hospitalization. Thrombolysis catheters were used in 27.7% (n = 981) and thrombectomy catheters in 3.9% (n = 138). Independent predictors of death or amputation included severe lung disease (OR: 1.72; 95% CI: 1.17-2.52), Rutherford Class IIb (OR: 2.44; 95% CI: 1.62-3.65), and end-stage renal disease (OR: 3.94; 95% CI: 0.73-0.85), and preprocedure hemoglobin (OR: 0.78; 95% CI: 0.73- 0.85). Complications included bleeding within 72 hours of intervention (6.7%) and thrombosis (2.8%). CONCLUSIONS Patients with pre-existing medical comorbidities and those with diminished limb viability were more likely to suffer adverse outcomes. Adverse event rates remain high for patients affected by acute limb ischemia despite its declining incidence. (JACC Cardiovasc Interv. 2024;17:2379-2390) (c) 2024 by the American College of Cardiology Foundation.