Objective To evaluate the association between procedural duration and periprocedural outcomes in patients with chronic limb-threatening ischemia (CLTI) who underwent endovascular therapy (EVT). Methods This retrospective single-center study included 347 consecutive patients (428 limbs) with CLTI who underwent successful EVT for de novo lesions between February 2008 and January 2021. Patients were stratified by procedural location into a prolonged group (>2 h; 203 limbs) and a standard group (≤2 h; 225 limbs). The primary endpoint was in-hospital mortality, and the secondary endpoint was postprocedural complications. Multivariate logistic regression analysis was performed to identify independent predictors of postprocedural complications. Results The prolonged group showed greater limb severity and lesion complexity, including a higher prevalence of Wound, Ischemia, and Foot Infection (WIfI) stage 4 (51.5% vs. 36.9%, P < 0.01), chronic total occlusion (65.2% vs. 48.4%, P < 0.01), and Global Limb Anatomic Staging System (GLASS) infrapopliteal grade 4 (71.1% vs. 53.1%, P < 0.01). In-hospital mortality did not differ significantly between the groups (2.0% vs. 0.4%; P = 0.14). However, postprocedural complications occurred significantly more frequently in the prolonged group (9.9% vs. 2.7%; P < 0.01). Multivariate analysis identified prolonged procedural duration as an independent predictor of postprocedural complications (odds ratio [OR], 3.30; 95% confidence interval [CI], 1.23–8.85; P = 0.02), along with bedridden status (OR, 4.15; 95% CI, 1.64–10.6; P < 0.01) and GLASS inframalleolar grade 2 (OR, 3.29; 95% CI, 1.34–8.10; P < 0.01). Conclusions Prolonged procedural duration was independently associated with an increased risk of postprocedural complications in patients with CLTI undergoing EVT. Thus, procedural time may serve as a marker of lesion complexity and procedural burden and may assist intraprocedural decision-making.
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