Importance of Successful Revascularization in Acute Limb Ischemia: Sub-Analysis From the RESCUE ALI Trial

Abstract

Background: This study aimed to assess the 1-year clinical outcomes and predictors of technical success in acute limb ischemia (ALI) treatment.

Methods: A sub-analysis of the REtroSpective multiCenter study of endovascUlar or surgical intErvention for ALI (RESCUE ALI) study involved 185 patients with ALI and technical success (n = 131) or failure (n = 54) treated via surgical, endovascular, or hybrid revascularization between January 2015 and August 2021. The primary endpoint was 1-year amputation-free survival (AFS), and the secondary endpoints included preoperative complications and 1-year reintervention.

Results: The technical success group had a significantly higher 1-year AFS rate than the technical failure group (79% vs. 44%, p < 0.001). Perioperative complications rate showed no significant difference between the two groups. The incidence of reintervention was lower in the technical success group (17% vs. 30%, p = 0.049). Age ≥ 80 years, time from onset ≥ 24 h, no below-the-knee artery runoff, and preoperative c-reactive protein ≥ 5 mg/dL were negatively associated with technical success across all procedures. In surgical revascularization, no below-the-knee artery runoff was negatively associated with technical success. For endovascular revascularization, onset-to-treatment time ≥ 48 h was negatively related and thromboembolism in atrial fibrillation was positively related to technical success. In hybrid revascularization, supra- to infrapopliteal lesions were negatively associated with technical success.

Conclusions: Technical success in ALI treatment significantly enhances 1-year AFS rates. Thus, choosing the appropriate revascularization procedure based on predictors of technical success is crucial for improving patient outcomes.

Keywords: acute limb ischemia; amputation‐free survival; below‐the‐knee artery; endovascular treatment; preoperative c‐reactive protein.