HAS after OLT can be treated endovascularly with high technical success and excellent primary assisted patency. This series represents the largest reported cohort of endovascular interventions for HAS to date. Initial use of a stent showed a strong trend toward decreasing the need for reintervention. Avoidance of hepatic artery thrombosis is possible in >95% of patients with endovascular treatment and close follow-up.

subsequently had postrevascularization APs or TPs greater than the CLI criteria were removed from the cohort. Demographic factors, wound healing, amputation rates, and mortality were obtained and analyzed in relation to the initial APs and TPs. Outcomes were measured using Kaplan-Meier life-table analysis and Cox proportional hazards models.Results: CLI criteria were identified in 443 limbs of 381 patients. After revascularization, 98 limbs with AP or TP, or both, improved to >70 mm Hg and 50 mm Hg were removed from the study cohort. In 45 limbs, patients did not respond to the intial revascularization and their APs or TPs, or both, remained within CLI criteria. These limbs remained in the patient cohort, yielding a final group of 296 patients and 345 limbs. Mean follow-up time was 2.0 years. In the entire patient cohort, limb loss occurred in 24% at 1 year and in 31% at 3 years. Mortality was 32% at 1 year and 56% at 3 years. Amputation-free survival was 54% at 1 year and 28% at 3 years. Lower TPs were associated with a significantly higher incidence of amputation. Among the 85 with an initial TP #10 mm Hg, limb loss occurred in 46% at 1 year and in 60% at 3 years. This limb loss was significantly greater than limb loss of 18% at 3 years among the 115 with a TP of 31 to 50 mm Hg (P < .001, Fig). Amputation-free survival in patients with a TP #10 mm Hg was 8% at 3 years.Conclusions: CLI is associated with a high mortality, but not all patients with currently defined hemodynamic criteria for CLI are at high risk of limb loss. Patients with a TP between 31 and 50 mm Hg (41% of the cohort) and not receiving revascularization or not responding hemodynamically to revascularization experienced a low risk of limb loss. We recommend revising the hemodynamic criteria for CLI to better identify patients at high risk for limb loss who require intervention to improve outcomes.

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