Short-Term Outcomes of Lower-Extremity Surgical Revascularization for Chronic Limb-Threatening Ischemia Among Yemeni Patients: A Prospective Observational Study

Background: Chronic limb-threatening ischemia (CLTI) carries a high risk of amputation and mortality.We evaluated short-term clinical, hemodynamic, and quality-of-life outcomes after open lower-extremity surgical revascularization in a Yemeni cohort.Methods: This single-center prospective observational cohort study was conducted at Al-Thawra Modern General Hospital, Sana'a, Yemen.We enrolled 39 consecutive adults with CLTI (Rutherford categories 4-6) who were selected for and considered fit to undergo open lower-extremity surgical revascularization between December 2022 and September 2024; follow-up was completed in December 2024.The study protocol was reviewed and approved by the Al-Thawra Hospital Ethics Committee (approval no.33-2026), and written informed consent was obtained from all participants.The study was not registered.This was an exploratory consecutive cohort; no formal sample-size calculation was performed, and no contemporaneous endovascular, nonoperative, or primary-amputation comparator group was included.Primary endpoints were graft patency and limb salvage at three months.Secondary outcomes were secondary patency, postoperative complications, and changes in ankle-brachial index (ABI) and Vascular Quality of Life Questionnaire-6 (VascuQoL-6) scores.Paired comparisons used Wilcoxon signed-rank tests; Fisher's exact tests were used for categorical comparisons.Results: The mean age was 60.9 years (SD 9.7), and 30 patients (76.9%) were male.Diabetes mellitus and hypertension were present in 34 (87.2%) and 30 (76.9%) patients, respectively.Nineteen patients (48.7%) had ischemic rest pain, and 20 (51.3%) had tissue loss.Great saphenous vein (GSV) and polytetrafluoroethylene (PTFE) grafts were used in 28 (71.8%) and 11 (28.2%)patients, respectively.At three months, primary patency was 84.6% (33/39 grafts; 95% CI 70.3%-92.8%),secondary patency was 89.7% (35/39 grafts; 95% CI 76.4%-95.9%),and limb salvage was 89.7% (35/39 patients; 95% CI 76.4%-95.9%).Given the small cohort, the confidence intervals around these estimates were relatively wide.Among the 35 patients with limb preservation, mean ABI increased from 0.35 (SD 0.11) to 0.55 (SD 0.12; mean difference 0.21, 95% CI 0.19-0.23;p<0.001), and mean VascuQoL-6 score increased from 10.3 (SD 2.9) to 16.6 (SD 4.0; mean difference 6.3, 95% CI 5.6-7.1;p<0.001).Complications occurred in nine patients (23.1%).In an exploratory unadjusted subgroup analysis, GSV use was associated with higher primary patency than PTFE use (92.9% vs 63.6%, p=0.042).Conclusion: In this single-center prospective cohort, open surgical revascularization was feasible and was associated with 89.7% limb salvage and 84.6% primary patency at three months.Improvements in ABI and VascuQoL-6 were observed among patients with limb preservation.Autologous GSV use was associated with higher primary patency; this finding requires confirmation in larger, adjusted studies.