Abstract
<title>Abstract</title> <p>Objective This single-center retrospective cohort study compared open surgery(Open) versus endovascular therapy (EVT) for acute lower limb ischemia. Methods A total of 92 patients were enrolled (37 in the Open group, 55 in the EVT group). The primary endpoints were major adverse limb events (MALE) and cardiovascular/cerebrovascular mortality(MACE) . Results The open surgery group had lower rates of clinically driven target lesion revascularization (5.02% vs. 22.01%) and MALE (10.38% vs. 33.76%) at one year (HR for MALE = 0.34, P = 0.047). No significant difference was observed in major adverse cardiovascular and cerebrovascular events (MACE) between the two groups (HR = 1.86, P = 0.239). Subgroup analyses revealed that in patients aged ≥ 80 years, female sex, hemoglobin < 160 g/L, platelet count ≥ 180, or urea ≥ 6.28, open surgery was associated with a significantly higher risk of MACE (HR = 7.69, 10.44, 5.99, 9.76, and 9.90, respectively; all P < 0.05). In patients aged < 80 years, open surgery had a lower risk of MALE (HR = 0.17, P = 0.028). In patients with neutrophil count < 7, the aspiration group had a significantly lower risk of MALE than open surgery (HR = 0.12, P = 0.048). Conclusion Open thrombectomy may be superior to aspiration thrombectomy in preventing limb-related events at one year, but it carries higher cardiovascular and cerebrovascular risks in elderly, female, anemic, or those with elevated platelet count or renal dysfunction. Treatment should be individualized. Clinical trial registration Not applicable. This study was a retrospective observational cohort study and was not a clinical trial.</p>