Significance of Recovery of Limb Function After Surgical Revascularization in Chronic Limb-Threatening Ischemia

Abstract

Wound healing and ambulation could be pivotal goals in treatment of chronic limb-threatening ischemia (CLTI). To show the impact these limb functions have on the patient’s prognosis, the wound-free ambulation (WFA) rate was evaluated as a new end point. Based on clinical outcomes of 187 patients (225 limbs) who underwent surgical revascularization for CLTI between January 2012 and December 2017 in a single center (74% diabetes and 50% dialysis), WFA, which was the end point to complete wound healing and achievement of ambulation after revascularization, was assessed. Significance of WFA in patients’ prognosis and factors associated with WFA were analyzed by the Cox proportional hazards model. WFA rate reached 52% at 3 months and 65% at 6 months after surgery. Wound, Ischemia, and foot Infection (WIfI) clinical stage did not alter patients’ survival rate in this series; however, WFA clearly stratified patients’ prognosis in CLTI. There was significant difference in 2-year survival rate between patients who achieved WFA and patients who did not (73% and 40%; P < .01). In particular, WFA was the strongest factor associated with postoperative patients’ prognosis. Multivariate analysis demonstrated four statistically significant predictors of WFA: heart failure (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.32-0.70), low nutrition (serum albumin concentration <3.0 g/dL; HR, 0.64; 95% CI, 0.42-0.98), limb severity expressed by WIfI classification (HR, 0.16; 95% CI, 0.09-0.26), and loss of ambulation on CLTI onset (HR, 0.25; 95% CI, 0.16-0.40). Thus, WFA was a comprehensive factor including these multiple factors associated with patients’ survival rate in CLTI. Limb function expressed by WFA was related to postoperative patients’ prognosis after revascularization. Recovery of limb function after revascularization might be an important end point to extend a life prognosis of CLTI patients.