Predictors and clinical course of chronic limb-threatening ischemia with hemodynamic failure after endovascular therapy

Abstract

Background:

Hemodynamic failure, defined as insufficient postprocedural improvement in limb perfusion, occurs frequently after endovascular therapy (EVT). However, the predictors of hemodynamic failure and its clinical course have not been adequately investigated. This study aimed to investigate the predictors and clinical course of chronic limb-threatening ischemia (CLTI) with hemodynamic failure after EVT.

Methods:

This retrospective, multicenter analysis of the SAPLING database included 924 patients with CLTI and tissue loss who underwent EVT between April 2010 and March 2023, with skin perfusion pressure (SPP) measured pre- and postprocedure. Hemodynamic failure was defined as postprocedural SPP < 40 mmHg. Kaplan–Meier analysis evaluated cumulative wound healing, reintervention, and wound recurrence. Logistic regression and Cox proportional hazards models identified predictors of hemodynamic failure and wound healing.

Results:

Hemodynamic failure occurred in 52.2% (482/924) of cases. Multivariable analysis identified lower preprocedural SPP and the absence of wound blush as independent predictors. Stratified analysis revealed the highest hemodynamic failure rate in patients with preprocedural SPP < 20 mmHg and absent wound blush (66.5%). Patients with hemodynamic failure showed significantly lower wound healing rates and higher rates of reintervention and wound recurrence (all p < 0.05). Factors independently associated with delayed wound healing included age ⩾ 75 years, nonambulatory status, hemodialysis, hemodynamic failure, Wound, Ischemia, and foot Infection (WIfI) stage 4, and the absence of wound blush.

Conclusions:

Hemodynamic failure after EVT was common and strongly associated with delayed wound healing, reintervention, and wound recurrence. Preprocedural SPP and wound blush assessment may be useful for identifying patients at high risk for hemodynamic failure.