ArticlePakistan journal of medical sciences2026
New Method of Percutaneous Revascularization Treating Severe and Hard-to-Treat Chronic Limb-Threatening.
Article in Pakistan journal of medical sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background & Objective: Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease and is associated with high risks of limb loss and mortality. Contemporary management increasingly favors endovascular revascularization; however, optimal outcomes depend on structured multidisciplinary care in addition to technical success. This study aimed to evaluate clinical and hemodynamic outcomes of endovascular revascularization performed within a multidisciplinary limb salvage program in patients with advanced CLTI, with a focus on amputation-free survival (AFS) and limb preservation. Methodology: This retrospective single center study included 79 consecutive patients with advanced CLTI who underwent endovascular revascularization between January 2019 and December 2023. All patients received standardized guideline-directed medical therapy and multidisciplinary postoperative care. Hemodynamic improvement was assessed by pre- and post-procedural ankle-brachial index (ABI). AFS was evaluated using Kaplan-Meier analysis at 12 months. Univariable Cox regression analysis was performed to explore predictors of adverse AFS events. Results: Mean ABI increased significantly from 0.61 ± 0.20 preoperatively to 0.89 ± 0.23 postoperatively (paired t test, p < 0.001). Kaplan-Meier analysis demonstrated a 12-month amputation-free survival rate of 89.2% (95% CI, 82.1-96.3). Primary and secondary patency rates were 67.1% and 27.8%, respectively. Major amputation occurred in 3.8% of patients, while overall mortality was 1.3%. In univariable analysis, diabetes mellitus and total arterial occlusion were significantly associated with reduced amputation-free survival. Conclusion: Endovascular revascularization integrated within a multidisciplinary limb salvage program is a safe and effective strategy for patients with advanced CLTI. This approach achieves significant hemodynamic improvement, high amputation-free survival, and low rates of major limb loss despite complex anatomy and severe disease burden.
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