Two-year clinical outcomes following lower limb endovascular revascularisation for chronic limb-threatening ischaemia at a tertiary Asian vascular centre in Singapore

Abstract

INTRODUCTION Percutaneous transluminal angioplasty (PTA) is commonly used to treat patients with chronic limb-threatening ischaemia (CLTI). This study aimed to examine the mortality and functional outcomes of patients with CLTI who predominantly had diabetes mellitus in a multi-ethnic Asian population in Singapore. METHODS Patients with CLTI who underwent PTA between January 2015 and March 2017 at the Vascular Unit at Singapore General Hospital, Singapore, were studied. Primary outcome measures were 30-day unplanned readmission, two-year major lower extremity amputation (LEA), mortality rates, and ambulation status at one, six and 12 months. RESULTS A total of 221 procedures were performed on 207 patients, of whom 184 (88.9%) were diabetics. The one-, six- and 12-month mortality rate was 7.7%, 16.4% and 21.7%, respectively. The two-year LEA rate was 30.0%. At six and 12 months, only 96 (46.4%) and 93 (44.9%) patients were ambulant, respectively. Multivariate analysis revealed that preoperative ambulatory status, haemoglobin, Wound Ischaemia and foot Infection (WIfI) score, and end-stage renal failure (ESRF) were independent predictors of one-year ambulatory status. Predictors of mortality at one, six and 12 months were ESRF, preoperative albumin level, impaired functional status and employment status. CONCLUSION PTA for CLTI was associated with low one-year mortality and two-year LEA rates but did not significantly improve ambulation status. ESRF and hypoalbuminaemia were independent predictors of mortality. ESRF/CKD and WIfI score were independent predictors of loss of ambulation at six months and one year. We need better risk stratification for patients with CLTI to decide between initial revascularisation and an immediate LEA policy.

Heal or no heel: Outcomes of ischaemic heel ulcers following lower limb revascularization from a multi‐ethnic Asian Cohort in Singapore

“…This coordinated effort is well established in our institution, which sees over 900 limb salvage procedures a year. 26 The results of the univariate and multivariate analyses were consistent with the existing literature. A higher WIFI score and Rutherford class predicted poorer AFS at 6 and 12 months, and Rutherford class and preoperative PTA occlusion predicted poorer overall survival at six and 12 months.…”

“…Our data suggests that with persistence in wound management, including undergoing multiple sessions of specialised negative pressure dressings and debridements, as well as dedicated multidisciplinary team involving wound nurses and podiatrists, heel wounds may have a better chance of healing post revascularisation. This coordinated effort is well established in our institution, which sees over 900 limb salvage procedures a year 26 …”

World’s First Experience Treating TASC II C and D Tibial Occlusive Disease Using the Selution SLR Sirolimus-Eluting Balloon: Six-Month Results From the PRESTIGE Study

“…The center performs approximately 900 lower limb angioplasty interventions annually; majority (95% cases) for CLTI. 19 Patient demographics, comorbidities, tissue loss severity based on the Rutherford scale 18 were prospectively collected into a case report file. Procedural data of interest were TASC II lesion severity, 20 number of tibials treated, and tibial wall calcification severity.…”

The modified frailty index-11 predicts medium-term outcomes after endovascular revascularisation for chronic limb threatening ischaemia in Asian patients

“…Further technical details of the angioplasty procedure and outcomes have been previously published. 15 Post-intervention, all patients received at least a single antiplatelet agent and statin therapy.…”