Abstract
Objective Chronic limb-threatening ischemia (CLTI) is associated with high morbidity and mortality.
Classification methods differentiate into patients with rest pain or with ischemic
ulcers. No distinction is made between the presence or absence of rest pain in patients
with ischemic ulcers. Our aim is to determine any differences in outcome between these
subdivisions so we can improve preoperative counseling and risk assessment.
Materials and Methods This multicenter retrospective cohort study included all patients revascularized
for a first episode of CLTI between 2013 and 2018. The cohort was divided in three
groups: patients with solely rest pain (RP), solely ischemic ulcers (IU), and patients
with both rest pain and ischemic ulcers (RP + IU). Baseline characteristics, morbidity,
and mortality were analyzed.
Results A total of 624 limbs in 599 patients were included: 225 (36.1%) in the rest pain
group, 169 (27.1%) in the ischemic ulcers group, and 230 (36.2%) in combined group.
Amputation rates were higher in the combined group at 6 months. Mortality rates were
significantly higher in the ischemic ulcers group and the combined group at 6 months
and 1 year.
Conclusion Patients with solely rest pain have significantly lower mortality rates in comparison
to patients with ischemic ulcers. Rest pain did not affect mortality rates in patients
with ulcers. There was a higher amputation rate in patients with combined rest pain
and ischemic ulcers because the presence of rest pain CLTI patients had a significant
negative effect on amputation risk. A separate subdivision for patients with combined
ulcers and rest pain is indicated.
Keywords
chronic limb-threatening ischemia - ischemic ulcers - rest pain - Rutherford classification
