Aortic & peripheral vascular diseaseSecondary analysis
Efficacy and safety of revascularization in patients with chronic limb-threatening ischemia by kidney function
- post hoc secondary analysis of BEST-CLI trial
- adjusted for inverse probability treatment weights
Authors' conclusion
Surgical vs endovascular revascularization was consistently associated with fewer days with MALE across CKD strata. However, its association with mortality varied by kidney function, attenuating the overall benefit for the composite endpoint of MALE or death. These results support individualized revascularization strategies, but require prospective confirmation.
Study context
- Population
- Patients with chronic limb-threatening ischemia (CLTI), stratified by baseline estimated glomerular filtration rate (eGFR)patients with CLTI
- Participants
- 1,704 patients
- Comparison
- surgical vs endovascular revascularization, by kidney function
- Primary endpoint
- Composite of:
- Major adverse limb events (MALE) or death
- Difference in restricted mean time lost (RMTL, in days)
Primary result
As reported in the abstract
Surgical revascularization vs Endovascular revascularizationRMTL difference, days (95% CI)
non-CKD
−127.8(−176.1 to −79.6)
mild-moderate CKD
−63.2(−104.7 to −21.8)
advanced CKD
−16.4(−78.8 to 46.0)
Further findings
Mortality
- diminishing mortality benefit with more severe chronic kidney disease (CKD)
- P interaction = .01
Major adverse limb events (MALE)
- association with fewer days with MALE remained consistent across CKD strata
- P interaction = .34
Original publication
Efficacy and safety of revascularization in patients with chronic limb-threatening ischemia by kidney function. Am Heart J. Published 5 August 2026. doi:10.1016/j.ahj.2026.107550
Summarised from the published abstract; every number is checked against it