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Abstract Objective: To evaluate limb-salvage outcomes, technical success, and clinical predictors of amputation in patients with chronic limb-threatening ischaemia (CLTI) undergoing below-the-knee (BTK) angioplasty in an Indian tertiary centre. Methods: A retrospective analysis of 251 patients with Rutherford class V and VI CLTI treated with percutaneous transluminal angioplasty (PTA) between January 2020 and January 2023 was performed. The primary outcome was limb salvage, defined as avoidance of major (above-ankle) amputation. Secondary outcomes included technical success, mortality, and factors associated with limb loss. Results: Technical success was achieved in 95.6 %. Limb salvage at 24 months was 92.5 % for Rutherford V and 92.2 % for Rutherford VI disease. Minor (toe/ray) amputations were required in 52.9 % during follow up . Diabetes (88.8 %) , Hypertension (70.9%) and Coronary artery disease (34.6%) Chronic kidney disease (16 %) were associated with higher rates of amputation. Post-procedural dual-pathway inhibition and statin therapy were commonly used and may have contributed to improved event-free survival. Conclusion: In this real-world Indian cohort with advanced CLTI, late presentation and heavy metabolic burden, isolated BTK angioplasty achieved acceptable limb salvage using plain balloon angioplasty alone. While outcomes compare favourably with published literature, absence of anatomical stratification and perfusion-based scoring limits broader generalisability. These results reflect pragmatic outcomes in a resource-constrained environment.
Gupta et al. (Wed,) studied this question.
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