Early Versus Delayed Endovascular Revascularization: Implications for Limb Salvage and Survival After Transmetatarsal Amputation
- 1Department of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, Cleveland, Ohio
- 2Hawken School, Cleveland, Ohio
- 3Department of Medicine, University Hospitals, Cleveland, Ohio
Abstract
Background: Healing after transmetatarsal amputation (TMA) depends on adequate tissue perfusion. Revascularization prior to minor amputation improves amputation-free survival, limb preservation, and wound healing in patients with ischemic wounds. However, the optimal interval between revascularization and amputation remains unclear.
Methods: The TriNetX real-world clinical data platform was used to identify patients with chronic limb-threatening ischemia (CLTI) who underwent endovascular revascularization followed by TMA. Patients were categorized into early TMA (≤7 days after revascularization) and late TMA (8-30 days). Propensity score matching was performed using demographics, comorbidities, laboratory values, and concurrent therapies. Major amputation and all-cause mortality at 6 months and 1 year were evaluated using Cox proportional hazards models. Kaplan–Meier curves and log-rank tests were used for time-to-event analyses.
Results: Among 700 patients with CLTI treated with revascularization before TMA, 508 underwent early TMA and 192 underwent late TMA. After matching, 185 patients remained in each group (96.3% match rate). The mean age was 66.9 ± 10.9 years, 78.1% were male, and mean follow-up was 237.2 days. At 6 months, major amputation (hazard ratio [HR], 0.87; 95% CI, 0.51-1.46; P =.597) and all-cause mortality (HR, 0.74; 95% CI, 0.45-1.20; P = .220) did not differ between groups. At 1-year, major amputation (HR, 0.87; 95% CI, 0.52-1.45; P = .599) and mortality (HR, 0.73; 95% CI, 0.46-1.14; P = .164) also remained similar. A composite endpoint of major amputation or all-cause mortality was also similar between groups (HR, 0.995; 95% CI, 0.694-1.425; P = .978).
Conclusion: Among patients with CLTI undergoing endovascular therapy and subsequent TMA, early (≤7 days) vs late (8-30 days) amputation timing did not significantly affect major amputation or survival outcomes.
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BibTeX
@article{yahyavi2026early,
title = {{Early Versus Delayed Endovascular Revascularization: Implications for Limb Salvage and Survival After Transmetatarsal Amputation}},
author = {Ashkan Yahyavi and Leen Hussein and Zakarias H. Shishehbor and Yara Shatnawi and Maedeh Zokaei Nikoo and Mehdi H. Shishehbor},
journal = {Journal of the Society for Cardiovascular Angiography \& Interventions},
year = {2026},
month = aug,
doi = {10.1016/j.jscai.2026.105623},
url = {https://doi.org/10.1016/j.jscai.2026.105623},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Early Versus Delayed Endovascular Revascularization: Implications for Limb Salvage and Survival After Transmetatarsal Amputation
AU - Ashkan Yahyavi
AU - Leen Hussein
AU - Zakarias H. Shishehbor
AU - Yara Shatnawi
AU - Maedeh Zokaei Nikoo
AU - Mehdi H. Shishehbor
PY - 2026
DA - 2026/08/27
JO - Journal of the Society for Cardiovascular Angiography & Interventions
DO - 10.1016/j.jscai.2026.105623
UR - https://doi.org/10.1016/j.jscai.2026.105623
AB - Background: Healing after transmetatarsal amputation (TMA) depends on adequate tissue perfusion. Revascularization prior to minor amputation improves amputation-free survival, limb preservation, and wound healing in patients with ischemic wounds. However, the optimal interval between revascularization and amputation remains unclear. Methods: The TriNetX real-world clinical data platform was used to identify patients with chronic limb-threatening ischemia (CLTI) who underwent endovascular revascularization followed by TMA. Patients were categorized into early TMA (≤7 days after revascularization) and late TMA (8-30 days). Propensity score matching was performed using demographics, comorbidities, laboratory values, and concurrent therapies. Major amputation and all-cause mortality at 6 months and 1 year were evaluated using Cox proportional hazards models. Kaplan–Meier curves and log-rank tests were used for time-to-event analyses. Results: Among 700 patients with CLTI treated with revascularization before TMA, 508 underwent early TMA and 192 underwent late TMA. After matching, 185 patients remained in each group (96.3% match rate). The mean age was 66.9 ± 10.9 years, 78.1% were male, and mean follow-up was 237.2 days. At 6 months, major amputation (hazard ratio [HR], 0.87; 95% CI, 0.51-1.46; P =.597) and all-cause mortality (HR, 0.74; 95% CI, 0.45-1.20; P = .220) did not differ between groups. At 1-year, major amputation (HR, 0.87; 95% CI, 0.52-1.45; P = .599) and mortality (HR, 0.73; 95% CI, 0.46-1.14; P = .164) also remained similar. A composite endpoint of major amputation or all-cause mortality was also similar between groups (HR, 0.995; 95% CI, 0.694-1.425; P = .978). Conclusion: Among patients with CLTI undergoing endovascular therapy and subsequent TMA, early (≤7 days) vs late (8-30 days) amputation timing did not significantly affect major amputation or survival outcomes.
SN - 2772-9303
ER -