Short-Term Outcomes of Lower-Extremity Surgical Revascularization for Chronic Limb-Threatening Ischemia Among Yemeni Patients: A Prospective Observational Study
- 1Department of Vascular Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana'a, YEM
- 2Department of Cardiac Surgery, Al-Thawra Modern General Hospital, Sana’a, YEM
- 3Department of Vascular Surgery, Al-Thawra Modern General Hospital, Sana'a, YEM
Abstract
Background: Chronic limb-threatening ischemia (CLTI) carries a high risk of amputation and mortality. We evaluated short-term clinical, hemodynamic, and quality-of-life outcomes after open lower-extremity surgical revascularization in a Yemeni cohort.
Methods: This single-center prospective observational cohort study was conducted at Al-Thawra Modern General Hospital, Sana'a, Yemen. We enrolled 39 consecutive adults with CLTI (Rutherford categories 4-6) who were selected for and considered fit to undergo open lower-extremity surgical revascularization between December 2022 and September 2024; follow-up was completed in December 2024. The study protocol was reviewed and approved by the Al-Thawra Hospital Ethics Committee (approval no. 33-2026), and written informed consent was obtained from all participants. The study was not registered. This was an exploratory consecutive cohort; no formal sample-size calculation was performed, and no contemporaneous endovascular, nonoperative, or primary-amputation comparator group was included. Primary endpoints were graft patency and limb salvage at three months. Secondary outcomes were secondary patency, postoperative complications, and changes in ankle-brachial index (ABI) and Vascular Quality of Life Questionnaire-6 (VascuQoL-6) scores. Paired comparisons used Wilcoxon signed-rank tests; Fisher's exact tests were used for categorical comparisons.
Results: The mean age was 60.9 years (SD 9.7), and 30 patients (76.9%) were male. Diabetes mellitus and hypertension were present in 34 (87.2%) and 30 (76.9%) patients, respectively. Nineteen patients (48.7%) had ischemic rest pain, and 20 (51.3%) had tissue loss. Great saphenous vein (GSV) and polytetrafluoroethylene (PTFE) grafts were used in 28 (71.8%) and 11 (28.2%) patients, respectively. At three months, primary patency was 84.6% (33/39 grafts; 95% CI 70.3%-92.8%), secondary patency was 89.7% (35/39 grafts; 95% CI 76.4%-95.9%), and limb salvage was 89.7% (35/39 patients; 95% CI 76.4%-95.9%). Given the small cohort, the confidence intervals around these estimates were relatively wide. Among the 35 patients with limb preservation, mean ABI increased from 0.35 (SD 0.11) to 0.55 (SD 0.12; mean difference 0.21, 95% CI 0.19-0.23; p<0.001), and mean VascuQoL-6 score increased from 10.3 (SD 2.9) to 16.6 (SD 4.0; mean difference 6.3, 95% CI 5.6-7.1; p<0.001). Complications occurred in nine patients (23.1%). In an exploratory unadjusted subgroup analysis, GSV use was associated with higher primary patency than PTFE use (92.9% vs 63.6%, p=0.042).
Conclusion: In this single-center prospective cohort, open surgical revascularization was feasible and was associated with 89.7% limb salvage and 84.6% primary patency at three months. Improvements in ABI and VascuQoL-6 were observed among patients with limb preservation. Autologous GSV use was associated with higher primary patency; this finding requires confirmation in larger, adjusted studies.
Related
- "Life and Lower Limb Threatening Condition" Clinical Features, Management and Outcomes of Diabetic Foot Ulcers Complicated by Gas Gangrene: A Prospective Cohort Study.
- Retrograde access revascularization in chronic limb threatening ischaemia.
- Safety and Preliminary Clinical Outcomes of Integrating Engineered Synthetic Lipid Vesicles (Biosomes) in a Skin Booster Protocol: A Prospective Observational Study
- Functional capacity improvement and cardiovascular events after lower extremity revascularization
- A Prospective, Observational, Open-Label, Nonrandomized, Multicenter Study Measuring Functional Outcomes in a Novel Interspinous Stabilization Device in Patients With Low Back Pain: 12-Month Results for the REFINE Study
BibTeX
@article{almodwahi2026shortterm,
title = {{Short-Term Outcomes of Lower-Extremity Surgical Revascularization for Chronic Limb-Threatening Ischemia Among Yemeni Patients: A Prospective Observational Study}},
author = {Nabeel Y Al-Modwahi and Ali M Fadhel and Al-Ezy M Hamoud and Yahya A Al-Modwahi and Emad A Halboob and Aref Al-Hashedi and Mohammed A Al-Mnari and Milad A Al-Motawakill},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117253},
url = {https://europepmc.org/article/PMC/PMC13722522},
note = {CC BY},
}
RIS
TY - JOUR
TI - Short-Term Outcomes of Lower-Extremity Surgical Revascularization for Chronic Limb-Threatening Ischemia Among Yemeni Patients: A Prospective Observational Study
AU - Nabeel Y Al-Modwahi
AU - Ali M Fadhel
AU - Al-Ezy M Hamoud
AU - Yahya A Al-Modwahi
AU - Emad A Halboob
AU - Aref Al-Hashedi
AU - Mohammed A Al-Mnari
AU - Milad A Al-Motawakill
PY - 2026
DA - 2026/09/30
JO - Cureus
DO - 10.7759/cureus.117253
UR - https://europepmc.org/article/PMC/PMC13722522
AB - Background: Chronic limb-threatening ischemia (CLTI) carries a high risk of amputation and mortality. We evaluated short-term clinical, hemodynamic, and quality-of-life outcomes after open lower-extremity surgical revascularization in a Yemeni cohort. Methods: This single-center prospective observational cohort study was conducted at Al-Thawra Modern General Hospital, Sana'a, Yemen. We enrolled 39 consecutive adults with CLTI (Rutherford categories 4-6) who were selected for and considered fit to undergo open lower-extremity surgical revascularization between December 2022 and September 2024; follow-up was completed in December 2024. The study protocol was reviewed and approved by the Al-Thawra Hospital Ethics Committee (approval no. 33-2026), and written informed consent was obtained from all participants. The study was not registered. This was an exploratory consecutive cohort; no formal sample-size calculation was performed, and no contemporaneous endovascular, nonoperative, or primary-amputation comparator group was included. Primary endpoints were graft patency and limb salvage at three months. Secondary outcomes were secondary patency, postoperative complications, and changes in ankle-brachial index (ABI) and Vascular Quality of Life Questionnaire-6 (VascuQoL-6) scores. Paired comparisons used Wilcoxon signed-rank tests; Fisher's exact tests were used for categorical comparisons. Results: The mean age was 60.9 years (SD 9.7), and 30 patients (76.9%) were male. Diabetes mellitus and hypertension were present in 34 (87.2%) and 30 (76.9%) patients, respectively. Nineteen patients (48.7%) had ischemic rest pain, and 20 (51.3%) had tissue loss. Great saphenous vein (GSV) and polytetrafluoroethylene (PTFE) grafts were used in 28 (71.8%) and 11 (28.2%) patients, respectively. At three months, primary patency was 84.6% (33/39 grafts; 95% CI 70.3%-92.8%), secondary patency was 89.7% (35/39 grafts; 95% CI 76.4%-95.9%), and limb salvage was 89.7% (35/39 patients; 95% CI 76.4%-95.9%). Given the small cohort, the confidence intervals around these estimates were relatively wide. Among the 35 patients with limb preservation, mean ABI increased from 0.35 (SD 0.11) to 0.55 (SD 0.12; mean difference 0.21, 95% CI 0.19-0.23; p<0.001), and mean VascuQoL-6 score increased from 10.3 (SD 2.9) to 16.6 (SD 4.0; mean difference 6.3, 95% CI 5.6-7.1; p<0.001). Complications occurred in nine patients (23.1%). In an exploratory unadjusted subgroup analysis, GSV use was associated with higher primary patency than PTFE use (92.9% vs 63.6%, p=0.042). Conclusion: In this single-center prospective cohort, open surgical revascularization was feasible and was associated with 89.7% limb salvage and 84.6% primary patency at three months. Improvements in ABI and VascuQoL-6 were observed among patients with limb preservation. Autologous GSV use was associated with higher primary patency; this finding requires confirmation in larger, adjusted studies.
SN - 2168-8184
ER -