Abdullah NAAMAH, Houssam KINJO, Ali KAFA
Turkish Journal of Vascular Surgery - 2026;35(2):155-163
Aim: Chronic limb-threatening ischemia (CLTI), the advanced stage of lower extremity peripheral artery disease (PAD), is associated with high amputation rates, mortality, and diminished quality of life. This study aimed to evaluate treatment outcomes and identify independent predictors of poor outcomes in these patients. Material and Methods: This retrospective observational analytic study included CLTI patients (rest pain/tissue loss with absolute ankle pressure <50 mmHg) between January 2022 and March 2025 at Latakia University Hospital. Patients were categorized into interventional, deferred interventional, and conservative groups. Primary outcomes were 1-year amputation-free survival (AFS) and overall survival (OS). Results: The sample comprised 152 patients (mean age: 65.28 +/- 8.5 years); 47.4% underwent intervention within 6 weeks, 27.6% received conservative management, and 25.0% had deferred intervention after 6 weeks. No statistically significant differences occurred among groups regarding 1-year AFS (P = 0.60) or OS (P = 0.30). Interventional type (open vs. endovascular) did not significantly affect AFS or OS. Significant independent predictors affecting both AFS and OS were age, heart disease, chronic obstructive pulmonary disease (COPD), previous revascularization, and anemia. Moderate to severe renal failure independently predicted OS only. Conclusion: No significant outcome differences were detected among treatment strategies. Deferred intervention is feasible in selected patients without worsening short-term outcomes. Though not replacing indicated revascularization, conservative management may represent a reasonable approach yielding favorable 12-month outcomes in carefully selected patients. CLTI outcomes heavily depend on patient comorbidities and overall condition rather than solely limb clinical/anatomical staging. Age, heart disease, COPD, previous revascularization, anemia, and moderate to severe renal failure are crucial predictors of poor outcomes.
