Endovascular Management of Critical Limb Ischemia: Single Centre Experience from a Developing Country with Limited Resources

To evaluate the effectiveness of endovascular management i-e balloon angioplasty and stenting as a first-choice revascularisation procedure in patients with critical limb ischemia (CLI).

Materials and Methods: We performed a retrospective review of patients presenting between June 2015 to December 2021 with symptoms of critical limb ischemia who underwent endovascular intervention at a tertiary care hospital in Karachi, Pakistan. Cases performed by a multidisciplinary team comprised of Interventional Radiology & Vascular Surgery. Data was collected on baseline demographics, comorbidities, procedural and inventory details, and post procedure outcomes. The primary outcome was successful healing of the wound and resolution of pain. Mortality, major amputation, and patency was also assessed.

Results:

245 patients with clinical features of CLI underwent DSA for treatment purpose. Out of them 215 underwent endovascular treatment with either balloon angioplasty or combined with stenting. 30 patients did not receive endovascular treatment due to various causes such as acute thrombosis, severe distal disease etc and were managed either surgically or conservatively. Out of remaining 215 patients, 198 underwent balloon angioplasty and, 26 underwent stenting combined with angioplasty. Of the angioplasty group, 69 underwent both above & below the knee, 65 above knee only and 55 below the knee only angioplasties. Among the stenting group 14 underwent kissing aorto-illiac stenting, 9 illiac & 2 femoral stenting. The patients were followed for at least 6 and 9 months with mean follow-up of 15 months. The technical success rate was 90%. The primary patency rate was 78% and 70% at 6 & 9 months respectively. Major amputation rate was less than 10%. The complication rate was < 7% (mostly minor) with 2 periprocedural mortalities, one due to external illiac artery rupture and second due to acute MI during femoral angioplasty.

Conclusion:

Endovascular revascularization is associated with good primary patency and wound healing rates in patients presented with CLI and can play a vital role for limb salvage in patients who are in jeopardy of losing a foot or leg.