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• W4385993125 abstract "Major adverse limb events (MALE) differed significantly by revascularization approach in the BEST-CLI trial. We examined the nature and timing of MALE in a real-world tertiary care practice setting. This is a single-center retrospective study of patients who underwent technically successful infrainguinal revascularization for chronic limb-threatening ischemia (CLTI) (2011-2021). MALE was major amputation (MA; transtibial or above) or major reintervention (MR; new/revised bypass, thrombectomy or thrombolysis). Among 473 subjects, mean age was 70 years, and 34% were female. Characteristics included diabetes (68%), end-stage renal disease (16%), WIfI stage 4 (50%), GLASS stage 3 (63%) and high pedal artery calcium score (pMAC; 22%). Index revascularization was autogenous vein bypass (AVB; 143; 30%), non-autogenous bypass (NAB; 59; 13%), or endoluminal (ENDO; 267; 57%). Rates of MALE, MA, and MR at 30 days were 9% ± 1.4%, 5.8% ± 1.1%, and 3.3% ± 0.9%; and at 1 year were 29% ± 2.5%, 17% ± 1.9%, and 14% ± 1.9%, respectively. Median time to first MALE was 120 days (interquartile range, 27-414 days). In a Cox model inverse propensity-weighted for approach, MALE was independently associated with younger age, WIfI stage 4, high GLASS infrapopliteal grade, high pMAC, NAB, and ENDO (Figs 1, 2). Indications for MR were symptomatic stenosis/occlusion (54%), clinical nonimprovement (28%), asymptomatic graft stenosis (16%), and iatrogenic events (3%). Of those who experienced MALE, 36% underwent MR alone, 12% MR followed by MA, and 53% MA without prior MR. Index ENDO was associated with higher risk of MA without MR (P = .01). Conversion to bypass occurred after 6% of ENDO cases; two-thirds involved distal bypass targets at the ankle or foot. In this real-world cohort, disease complexity was significantly associated with MALE, and AVB independently provided the greatest durability. Compared with BEST-CLI randomized trial results, MALE after ENDO was more frequently MA rather than MR, with few conversions to bypass after index ENDO.Fig 2Inverse propensity-weighted Coz proportional hazards model for major adverse limb events (MALE), with revascularization approach weighted for associated factors as shown.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
• W4385993125 created "2023-08-19" @default.
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• W4385993125 date "2023-09-01" @default.
• W4385993125 modified "2023-10-06" @default.
• W4385993125 title "Relevance of BEST-CLI Trial Results in a Tertiary Care Limb Preservation Program" @default.
• W4385993125 doi "https://doi.org/10.1016/j.jvs.2023.06.089" @default.
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