Two-year clinical outcomes following lower limb endovascular revascularisation for chronic limb-threatening ischaemia at a tertiary Asian vascular centre in Singapore.
- Author:
Wei Ling TAY
1
;
Tze Tec CHONG
1
;
Sze Ling CHAN
2
;
Hao Yun YAP
1
;
Kiang Hiong TAY
3
;
Marcus Eng Hock ONG
2
;
Edward Tieng Chek CHOKE
4
;
Tjun Yip TANG
1
Author Information
- Publication Type:Journal Article
- Keywords: angioplasty; chronic limb-threatening ischaemia; functional outcome; limb salvage; revascularisation
- MeSH: Amputation; Chronic Disease; Chronic Limb-Threatening Ischemia; Humans; Ischemia/surgery*; Limb Salvage/methods*; Lower Extremity/surgery*; Peripheral Arterial Disease/surgery*; Retrospective Studies; Risk Factors; Singapore; Treatment Outcome
- From:Singapore medical journal 2022;63(2):79-85
- CountrySingapore
- Language:English
-
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.
