Abstract 10132: Outcomes of Peripheral Vascular Interventions for Lower Extremity Acute Limb Ischemia

Abstract

Introduction: Acute limb ischemia (ALI) is increasingly managed with peripheral vascular interventions (PVI). Objective: The objective of our study was to elucidate the clinical outcomes following PVI in patients with ALI. Methods: We identified 365 patients who underwent PVI for lower extremity ALI between 2010 and 2014 in the Vascular Study Group of New England registry. The control group included 1808 patients who underwent PVI for chronic critical limb ischemia (CLI) who were matched (5:1 to ALI) by arterial segment treated (aortoiliac, femoropopliteal, and infrapopliteal). Comparisons of in-hospital and two-year outcomes, including after adjustment for relevant clinical covariates, were made between the two groups. Results: Compared to CLI patients, ALI patients treated with PVI had lower prevalence of comorbidities but were more likely to have had prior ipsilateral revascularizations including PVI and/or leg bypass. ALI patients experienced lower technical success (89% vs 93%, p=0.04), higher rate of distal embolization (5% vs 2%, p=0.001), longer length of stay (6±8 days vs 4±6 days, p<0.001), and higher in-hospital mortality (4% vs 1%, p=0.001). No differences in two-year outcomes were found between the two groups with respect to rates of major amputation (6% vs 6%, p=0.9) and mortality (20% vs 21%, p=0.8). After adjustment for covariates and previous ipsilateral revascularizations, ALI continued to be associated with lower technical success (OR 0.6 [95% CI 0.4-0.8] p=0.008), higher rate of distal embolization (OR 2.7 [95% CI 1.5-4.9] p=0.001), longer length of stay (OR 1.6 [95% CI 1.4-1.8] p<0.001), and increased in-hospital mortality (OR 2.8 [95% CI 1.3-5.9] p=0.007). However, ALI was not associated with major amputation (HR 1.1 [95% CI 0.7-1.8] p=0.6) or mortality (HR 1.2 [95% CI 0.9-1.5] p=0.3) at two-year follow-up. Conclusions: In a large, observational cohort of patients undergoing PVI, those with ALI had more short-term adverse events compared to patients with CLI. However, two-year amputation rates and mortality were similar between ALI and CLI patients.