Clinical Outcomes after Revascularization in Patients with Chronic Limb-Threatening Ischemia.

Abstract

Chronic limb-threatening ischemia (CLTI) occurs in the advanced stage of peripheral artery disease and is associated with high risks of mortality and amputation. Universal management strategies are not always applicable, owing to population diversity, and the Western trials may not be applicable to Japanese patients, owing to differences in demographics and clinical profiles. This paper examines the outcomes of revascularization in Japanese CLTI patients and emphasizes the benefits of tailored management. Post-hoc analysis of the bypass versus angioplasty in severe ischemia of the leg (BASIL)-1 trial validated the use of the Global Limb Anatomic Staging System for predicting the outcomes of endovascular therapy (EVT) but not bypass surgery (BS). The SPINACH (surgical reconstruction versus peripheral intervention in patients with critical limb ischemia) registry revealed comparable 3-year amputation-free survival rates between patients who underwent EVT and those who underwent BS, with patient-specific factors such as limb status and general health influencing its success. Revascularization improved the quality of life, but benefits declined over time, especially in non-ambulatory and older patients on dialysis. Surgical reconstruction is better for preserving ambulation. Retrospective studies revealed pedal branch artery bypass as a viable option, functional independence as a predictor of survival, and zinc supplementation as promising for wound healing. Future research should focus on refining these strategies and exploring innovative approaches to overcome persistent challenges in CLTI care.