Revascularization Strategies and Outcomes in Critical Limb Ischemia: A Four-year Retrospective Study of 65 Patients in a Sub-Saharan Cardiovascular Surgery Center

Background: Critical limb ischemia (CLI) represents the most advanced stage of peripheral arterial disease (PAD) and remains associated with substantial morbidity and mortality. Data from Sub-Saharan Africa are scarce despite a rapidly increasing burden of disease. Objective: To evaluate the epidemiological characteristics, therapeutic strategies, and outcomes of patients treated for CLI in a tertiary cardiovascular surgery center. Methods: A retrospective study was conducted from January 2020 to December 2023, including 65 patients managed for CLI. Epidemiological, clinical, imaging, therapeutic, and outcome variables were analyzed. Results: Mean age was 65.3 years; 54% were male. Hypertension (58%), smoking (38%), and diabetes (34%) were the most common risk factors. Trophic lesions were present in 80% of cases. Endovascular therapy was performed in 70.7% of patients, bypass surgery in 15.4%, and thrombo-endarterectomy in 13.8%. Perioperative complications occurred in 37%. Mortality reached 14%. A total of 56 amputations were performed (25 minor, 31 major). Diabetes was significantly associated with minor amputation, while diabetes, hypertension, and smoking predicted major amputation. Primary patency was 61.5% at 1 month and 52.3% at 1 year. Conclusion: CLI remains a severe condition with high rates of complications, amputation, and mortality. Endovascular therapy was the predominant strategy with acceptable early patency. Earlier diagnosis and improved cardiovascular risk management are essential to improve outcomes in Sub-Saharan Africa.