The Difference in Mortality Rates Between Endovascular and Conservative Treatment for Patients with Chronic Limb-Threatening Ischemia: A Propensity Score Matching Study.

BACKGROUND: The main objective of this study was to examine the impact of endovascular therapy versus conservative therapy on mortality rates among patients with chronic limb-threatening ischemia (CLTI). In addition, the outcomes of amputation-free survival (AFS) were also studied in both groups.

METHODS: In this observational registry study, we retrospectively analyzed patients admitted to the Department of Vascular Surgery at Beijing Shijitan Hospital, Capital Medical University, from January 2016 to September 2023. Patients were categorized into an endovascular treatment group and a conservative treatment group. The primary endpoint was all-cause mortality. Propensity score matching was employed to balance covariates between the 2 groups, resulting in matched samples. We compared all-cause mortality between the groups and used univariate and multivariate Cox regression analyses to assess the impact of treatment on patient mortality both before and after matching.

RESULTS: A total of 120 patients with a mean age of (72 ± 11) years were enrolled in this study, comprising 76 patients in the endovascular treatment group and 44 patients in the conservative treatment group. The median follow-up duration was 33.5 (21.3-45.0) months, during which the all-cause mortality rate was 32 out of 120 (26.7%). In terms of clinical characteristics, significant differences were observed between the 2 groups regarding age, hypertension, Rutherford classifications, and Wounds, Ischemia, and foot Infection scores (P < 0.05). However, no significant differences were found in gender, diabetes, coronary artery disease, smoking status, hyperlipidemia, prior ischemic stroke, or lesion site (P > 0.05). Before propensity score matching, univariate Cox regression analysis indicated that age, gender, smoking status, Rutherford classifications, and Wounds, Ischemia, and foot Infection scores were significantly associated with patient mortality (P < 0.05). Multivariate Cox regression analysis revealed that age and smoking status were independently associated with patient mortality (P < 0.05). Using propensity score matching, 23 pairs of patients were successfully matched between the 2 groups. The 1-year and 3-year mortality rates in the endovascular group were 13.0% and 38.5%, respectively, compared to 17.4% and 36.0% in the conservative treatment group. No statistically significant differences were observed in 1-year (P = 0.681) or 3-year (P = 0.753) mortality rates between the 2 groups. Cox regression analysis also showed no significant difference in the risk of death between the 2 groups (hazard ratio [HR] 0.87, 95% cofidence interval [CI] 0.14-5.55; P = 0.880). AFS did not differ significantly between the 2 groups (Breslow-Wilcoxon P = 0.225).

CONCLUSION: No significant differences were observed in 1-year and 3-year mortality rates between endovascular treatment and conservative treatment, and not all patients with CLTI require revascularization to achieve an AFS that is similar to patients undergoing revascularization, although the efficacy of conservative versus endovascular treatment in CLTI patients is still unclear. Age and smoking status emerged as independent risk factors associated with an elevated risk of mortality.