Peripheral
Endovascular

Delays to revascularisation and outcomes of non-elective admissions for chronic limb threatening ischaemia: a UK population based cohort study

Selected in ESVS Journal by Jana Hammoud

This study evaluates the impact of revascularisation timing on mortality and major amputation rates in emergency admissions for chronic limb-threatening ischaemia (CLTI). Analysis of over 10,000 patients revealed that delays in revascularisation, particularly in those with tissue loss, were associated with higher one-year mortality rates, highlighting the importance of timely intervention for improving patient outcomes.
 

References:

Authors: Panagiota Birmpili, Qiuju Li, Amundeep S. Johal, Eleanor Atkins, Sam Waton, Arun D. Pherwani, Robin Williams, Ian Chetter, Jonathan R. Boyle, and David A. Cromwell

Reference: Published online December 24, 2024

DOI: 10.1016/j.ejvs.2024.12.038

Read the abstract

Objective:

The aim of this study was to evaluate the relationship between the timing of infrainguinal revascularisation and major amputation and mortality rates at one year for patients admitted to hospital as emergencies with CLTI.

Study:

Retrospective scanning of the Hospital Episode Statistics (HES) Admitted Patient Care (APC) database between 2017 and 2019 for patients with CLTI who underwent infra-inguinal revascularisation and the impact of timing on death and major amputation.

Population:

10,183 patients were identified with CLTI admitted as emergencies for infra-inguinal revascularisation.

Endpoint: 

Primary outcome was death at one year, and the secondary outcome was ipsilateral major amputation at one year after the index revascularisation procedure. Death and major amputation were also examined as time to event variables.

Outcomes and conclusion:

Patients undergoing infrainguinal revascularisation during non-elective admissions for CLTI have high one year major amputation and mortality rates. Longer time from admission to revascularisation was independently associated with a higher mortality rate in patients with tissue loss, but not in those without. 

Delays to revascularisation: Figure 1
Source: ESVS Journal
Delays to revascularisation: Figure 2
Source: ESVS Journal

Comments

Patients admitted as emergencies for critical limb ischemia (CLI):

  • 1-year mortality rate: 27.3 % (30 % with treatment, 19.9 % without)
  • 1-year major amputation rate: 15.7 % (16.4 % with treatment, 13.9 % without treatment)
  • Median time before revascularisation: 5 days (54.5 % of patients treated within 5 days)
  • Each additional day of waiting increases mortality by 3 % in treated patients (no association with major amputation)
  • If treated within 5 days, mortality decreases by 2.3 %

-> High mortality due to emergency admissions

-> No link between delay and major amputation, as severity and disease progression have a bigger impact

-> Patients treated later due to pre-operative treatments (e.g., antibiotics, optimisation, imaging) and hospital constraints

Strengths:

  • Large cohort of patients
  • Distinction between patients with and without trophic disorders
  • Consideration of confounding factors

Weaknesses:

  • Retrospective study
  • Based on a registry (no clinical evaluation)
  • Lack of information on risk factors (e.g., smoking, biological markers, atherosclerosis)
  • No development of techniques used
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Jana Hammoud