Role of Pedal Modifiers in Predicting Limb-based Patency in Chronic Limb Threatening Ischemia after Revascularization

Introduction: Chronic limb-threatening ischemia (CLTI) can potentially result in limb loss without revascularization. Inframalleolar modifier (IM) is described in global vascular guidelines, but there are no studies correlating outcomes in relation to IM. This study is designed to understand the effect of pedal modifiers in predicting limb-based patency in patients with CLTI after revascularization. Materials and Methods: This prospective study included patients above 18 years of age with CLTI with the primary objective of assessing limb-based patency and technical success of revascularization in relation to pedal modifier staging. The study was designed to include the technical success of revascularization, limb-based patency, amputation-free survival, quality of life scores, and adverse cardiovascular events. Results: Fifty-eight patients were included. Of them 47 (81%) were male, and 11 (19%) were female. The mean age was 68.05 years (range: 52–87 years). Six patients were of Rutherford Category 4, 49 were Category 5, and 3 were Category 6. Preoperative Vascular Quality of Life questionnaire-6 score ranged from 6 to 17 with a mean of 11.38. Seven patients (12%) were in IM modifier stage P0, 43 (74%) were in P1, and 8 (13.7%) were in P2. Three patients were lost to follow-up, four patients died, one patient had reintervention, and one patient underwent below-knee amputation. Technical success was seen in 51 (87.9%) patients. Based on pedal modifiers, it was 7/7 (100%) for P0, 38/43 (88%) for P1, and 6/8 (75%) for P2. Overall amputation-free survival was in 51 (87.9%). It was 7/7 (100%) for P0, 38/43 (88%) for P1, and 6/8 (75%) for P2. Limb-based patency was seen in 49 (84.4%) patients with 6/7 (85.7%), 37/43 (86%), and 6/8 (75%) for P0, P1, and P2, respectively. Conclusions: Patients with a complete pedal arch (P0) have better amputation-free survival and limb-based patency following revascularization.