Short Term Outcomes Following Secondary Interventions in Patients with Chronic Threatening Limb Ischemia

Background: Chronic Limb-Threatening Ischemia (CLTI) represents the most advanced stage of Peripheral Arterial Disease (PAD), often requiring reintervention due to restenosis or disease progression after initial revascularization. Methods: This prospective clinical study evaluated the short-term outcomes of secondary interventions among 30 CLTI patients previously treated with endovascular, surgical, or hybrid procedures at Minia University Hospital. Patients were followed for 1, 3, and 6 months to assess technical success and clinical improvement, including pain relief, ulcer healing, and gangrene progression. Statistical analysis and a Random Forest machine-learning model were employed to identify predictors of outcomes. Results: The study population had a mean age of 63±10 years, with males representing 66.7%. Common risk factors included diabetes (66.7%), hypertension (60%), heart disease (43.3%), and smoking (43.3%). Femoral (73.3%) and infrapopliteal (66.7%) lesions were predominant. Endovascular procedures constituted 96.7% of reinterventions, with intraoperative complications—such as dissection (16.7%), thrombosis (10%), and perforation (6.7%)—successfully managed. At six months, significant clinical improvement was noted: rest pain decreased from 96.7% to 32.1%, unhealed ulcers from 33.3% to 3.6%, and gangrene from 66.7% to 39.2%. Limb salvage reached 85.7%, with 10.7% requiring major amputation and 6.7% mortality. Machine learning highlighted gangrene severity and poor distal runoff as key predictors for amputation. Conclusion: secondary interventions, particularly endovascular approaches, effectively improve short-term outcomes and limb salvage in CLTI patients. However, individuals with renal impairment, advanced gangrene, or limited distal flow remain at elevated risk of amputation.