Clinical Outcomes and Predictive Factors in Acute Limb Ischemia: A 5-Year Retrospective Analysis at a Tertiary Referral Center.

BACKGROUND

Acute limb ischemia (ALI) remains a vascular emergency associated with high morbidity and mortality. Contemporary data on clinical outcomes and predictive factors in developing countries are limited. The objective of the study was to analyze clinical outcomes, treatment modalities, and predictive factors for amputation and mortality in patients with ALI at a Brazilian tertiary referral center.

METHODS

Retrospective observational study of 142 patients with ALI treated between January 2019 and December 2024 at a Brazilian tertiary referral center. Primary outcomes were 30-day amputation and mortality rates. Multivariate logistic regression was performed to identify independent predictors.

RESULTS

The mean age was 61.6 ± 18.1 years. Thrombotic etiology predominated (80.3%), with peripheral arterial disease (32%) and iatrogenic causes (22%) being the most frequent. Seventy percent presented with critical ischemia (Rutherford IIa-IIb). Open surgical revascularization was performed in 80% of cases, hybrid in 15%, and endovascular in 5%. Thirty-day amputation and mortality rates were 27% and 26%, respectively. Multivariate analysis identified Rutherford classification as an independent predictor of both amputation (odds ratio [OR] = 3.23, 95% confidence interval [CI] = 1.85-5.64, P < 0.001) and mortality (OR = 1.67, 95% CI 1.04-2.69, P = 0.033). Chronic kidney disease was independently associated with mortality (OR = 3.79, 95% CI 1.14-12.55, P = 0.029).

CONCLUSION

ALI remains associated with high morbidity and mortality. Clinical severity at admission and chronic kidney disease are independent predictors of adverse outcomes. Iatrogenic causes represent an emerging and significant etiology, highlighting the need for preventive protocols in contemporary vascular practice.