BACKGROUND Acute limb ischemia is a vascular emergency associated with high rates of limb loss and mortality. As the use of endovascular techniques increases, estimation of rates and predictors of adverse outcomes remains needed. OBJECTIVES This study sought to assess contemporary outcomes and predictors of adverse events following endovascular treatment of acute limb ischemia in a nationwide, multicenter registry. METHODS Patients who had peripheral vascular intervention performed for the indication of acute limb ischemia in National Cardiovascular Data Registry Peripheral Vascular Intervention Registry between 2014 and 2020 were included. The primary outcome was a composite of all-cause mortality and major amputation during index hospitalization. Multivariable logistic regression was employed to identify predictors of the composite outcome. RESULTS There were 3,541 endovascular procedures performed during the study period. Of these, 132 (3.7%) resulted in death, and 77 (2.2%) resulted in amputation during hospitalization. Thrombolysis catheters were used in 27.7% (n = 981) and thrombectomy catheters in 3.9% (n = 138). Independent predictors of death or amputation included severe lung disease (OR: 1.72; 95% CI: 1.17-2.52), Rutherford Class IIb (OR: 2.44; 95% CI: 1.62-3.65), and end-stage renal disease (OR: 3.94; 95% CI: 0.73-0.85), and preprocedure hemoglobin (OR: 0.78; 95% CI: 0.73- 0.85). Complications included bleeding within 72 hours of intervention (6.7%) and thrombosis (2.8%). CONCLUSIONS Patients with pre-existing medical comorbidities and those with diminished limb viability were more likely to suffer adverse outcomes. Adverse event rates remain high for patients affected by acute limb ischemia despite its declining incidence.

中文翻译：

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急性肢体缺血血管内血运重建的当代实践模式和结果。


背景 急性肢体缺血是一种与高肢体丧失率和死亡率相关的血管急症。随着血管内技术使用的增加，仍然需要估计发生率和不良结局的预测因子。目的 本研究试图在全国性的多中心登记中评估急性肢体缺血血管内治疗后不良事件的当代结局和预测因子。方法 纳入 2014 年至 2020 年在美国国家心血管数据登记处外周血管介入登记处为急性肢体缺血指征而进行外周血管介入治疗的患者。主要结局是指数住院期间全因死亡率和大截肢的复合结果。采用多变量 logistic 回归来确定复合结局的预测因子。结果研究期间进行了 3,541 例血管内手术。其中，132 例 （3.7%） 导致死亡，77 例 （2.2%） 在住院期间导致截肢。27.7% （n = 981） 使用溶栓导管，3.9% （n = 138） 使用血栓切除术导管。死亡或截肢的独立预测因素包括严重肺病（OR：1.72;95% CI：1.17-2.52）、卢瑟福 IIb 级（OR：2.44;95% CI：1.62-3.65）和终末期肾病（OR：3.94;95% CI：0.73-0.85）和术前血红蛋白（OR：0.78;95% CI：0.73-0.85）。并发症包括干预后 72 小时内出血 （6.7%） 和血栓形成 （2.8%）。结论 已有医学合并症的患者和肢体活力下降的患者更容易发生不良结局。尽管急性肢体缺血的发生率有所下降，但其不良事件发生率仍然很高。