Intraoperative Risk Factors for Complications of Open and Endovascular Revascularization in Acute Limb Ischemia

Acute limb ischemia (ALI) is characterized by a sudden reduction in arterial blood flow and may result in gangrene, systemic complications, and death. Urgent revascularization can be limb- and life-saving; however, it is associated with a risk of early postoperative complications. Both perioperative and intraoperative risk factors contribute to these outcomes and are influenced by the selected method of revascularization. The aim of this study was to assess the impact of intraoperative risk factors on postoperative outcomes according to the chosen treatment modality for acute limb ischemia, namely open or endovascular revascularization. Patients with Rutherford class II ALI from a single population were divided into two groups comparable in clinical and demographic characteristics: Group I – open surgical treatment (n = 50) and Group II – endovascular revascularization (n = 50). The influence of identified intraoperative risk factors on the development of complications differed between the two revascularization approaches. An operative time exceeding 85 minutes in the open surgery group (2.73) and exceeding 92 minutes in the endovascular group (1.52) was associated with an increased risk of adverse postoperative outcomes. The urgent nature of the procedure was also an independent predictor of adverse events in both groups, with ORs of 12.11 and 9.13 for Groups I and II, respectively. Outcomes of ALI treatment and the early postoperative course in the overall population depend on the selection of the revascularization method in accordance with each patient’s individual perioperative risk profile. Comparison of endovascular and open approaches demonstrated differences in outcomes favoring endovascular revascularization only in a specific subgroup of patients with a less severe functional class of limb ischemia.