Association of Chronic Limb Ischemia Rutherford Classification with Clinical Outcomes Following Lower Extremity Revascularization

Abstract

Background

The Rutherford Classification for chronic limb-threatening ischemia (CLTI) is used to categorize peripheral artery disease severity through history and physical examination. This study investigated whether higher Rutherford Classification correlates with worse clinical outcomes and could serve as a predictive tool.

Methods

In this prospective single-center study, 252 patients undergoing lower extremity revascularization were followed for 3 years (2020–2023). Rutherford classification was determined at presentation. Outcomes included reintervention for stenosis/occlusion, amputation rates, and mortality. Statistical analysis used chi-squared tests for categorical data and one-way ANOVA for continuous data.

Results

Higher Rutherford classifications (3–6) showed increased reoperation rates versus lower classifications (28.2% vs. 10.3%, P = 0.043), with the largest increase between classes 2 and 3 (4.7–26.8%). Amputation rates were significantly higher in classifications 4–6 vs. 0–3 (31.9% vs. 7.2%, P < 0.001), particularly between classes 4 and 5 (19.0–37.6%). Mortality rates were also higher in classes 4–6 vs. 0–3 (22.6% vs. 7.2%, P < 0.001).

Rutherford Classification effectively predicts major adverse outcomes, with marked increases at specific classification transitions suggesting critical thresholds for risk stratification. Early intervention may be warranted in higher classifications. These findings support its use as a valuable prognostic tool in preoperative planning and patient counseling.

Conclusion

This study validates Rutherford Classification as an effective tool for predicting adverse outcomes in CLTI patients. The clear correlation between higher classifications and increased complications supports its use in clinical decision-making, risk stratification, and determining optimal timing for surgical intervention.