One‐Year Clinical Outcomes of Endovascular Revascularization in Patients With Acute Limb Ischemia: Results of the Multicenter SKYLINE3 Study

Background Acute limb ischemia (ALI) is a critical vascular emergency associated with high risks of mortality and amputation. Aims This study aimed to investigate the 1‐year outcomes of Endovascular revascularization (EVR) in patients with ALI. Methods We retrospectively analyzed 304 EVR procedures in 280 patients with ALI between January 2018 and April 2025 in three cardiovascular centers. The primary endpoint was 1‐year amputation‐free survival (AFS). Secondary endpoints were 1‐year clinically driven target lesion revascularization (CD‐TLR) and procedural success. The association of baseline characteristics with 1‐year AFS was also investigated. Results The estimated 1‐year AFS rate was 65.2%, and freedom from CD‐TLR was 83.9%. Procedural success was achieved in 285 (93.8%) cases. Independent predictors of reduced 1‐year AFS included frailty (multivariable hazard ratio [mHR] 2.73; 95% confidence interval (CI), 1.62–4.61; p < 0.001), hemodialysis (mHR 2.76; 95% CI, 1.55–4.90; p = 0.001), severe ALI (mHR 1.70; 95% CI, 1.03–2.80; p = 0.037), and peak creatine phosphokinase (CPK) > 7000 IU/L (mHR 2.95; 95% CI, 1.80–4.83; p < 0.001). In contrast, preserved flow in one below‐the‐knee (BTK) artery (mHR 0.44; 95% CI, 0.22–0.91; p = 0.026) or in two or more BTK arteries (mHR 0.34; 95% CI, 0.17–0.69; p = 0.003) was independently associated with improved 1‐year AFS. Conclusions EVR may be an acceptable treatment for ALI. Frailty, hemodialysis, severe ALI, and peak CPK > 7000 IU/L are associated with poor prognosis. However, achieving adequate BTK arterial flow after EVR may correlate with improved patient outcomes.