Effect of Anaemia on Outcomes of Revascularisation for Chronic Limb-threatening Ischaemia

Pavankumar Kamat


October 22, 2021


  • Moderately severe peri-procedural anaemia was independently associated with reduced 1-year amputation-free survival (AFS) in patients undergoing revascularisation for chronic limb-threatening ischaemia (CLTI).

Why this matters

  • Given the negative outcomes associated with red blood cell (RBC) transfusion, the growing body of literature emphasises the need to determine which strategies can be implemented to address peri-procedural anaemia.

Study design

  • A retrospective study included 283 patients diagnosed with CLTI (2018-2019) who subsequently underwent revascularisation.

  • Anaemia severity was determined using sex-specific World Health Organization criteria.

  • Primary outcome: 1-year AFS (composite of death/major amputation).

  • Secondary outcome: length of stay (LoS) in hospital.

  • Funding: None.

Key results

  • Of 283 patients, 148 (52.3%) were anaemic.

  • Overall, 53 patients (18.7%) underwent RBC transfusion, of which 41 were anaemic at index assessment.

  • Patients with anaemia vs those with a normal haemoglobin concentration had a significantly lower rate of AFS (64.2% vs 78.5%; P=.009).

  • A significant difference was seen in 1-year AFS in patients who were stratified based on anaemia severity (P=.008).

  • Patients who received RBC transfusion vs those who did not, had a significantly lower rate of AFS (45.3% vs 77.0%; P<.001).

  • Moderately severe anaemia was independently linked to an increased risk of major amputation/death (adjusted HR [aHR], 1.90; 95% CI, 1.06-3.38; P=.030).

  • Peri-procedural RBC transfusion was significantly associated with an increased combined risk of major amputation/death (aHR, 3.15; 95% CI, 1.91-5.20; P<.001).

  • LoS in hospital was longer, but not significantly in patients with anaemia vs those without (median, 7 vs 5 days; P=.077).


  • Retrospective design.

  • Small sample size.


Theuma F, Nickinson ATO, Cullen S, Patel B, Dubkova S, Davies RSM, Sayers RD. The impact of anaemia on one-year amputation-free survival in patients undergoing revascularisation for chronic limb-threatening ischaemia: a retrospective cohort study. Ann Vasc Surg. 2021 Oct 10 [Epub ahead of print]. doi: 10.1016/j.avsg.2021.07.020. PMID: 34644651  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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