Abstract 10326: Do Veterans Having Superficial Femoral Artery Revascularization Have Worse Disease and Poorer Long-Term Outcomes Than Non-Veterans?

Abstract

Introduction: Veteran Affairs (VA) patients may have higher risk factors and worse outcomes after peripheral revascularization compared to patients treated in non-VA facilities. Hypothesis: Compared to non-VA patients, VA patients have higher rates of risk factors and poorer outcomes after superficial femoral artery (SFA) endovascular revascularization. Methods: We assessed long-term outcomes in all patients having SFA endovascular revascularization between 2003-2010 in 2 regional referral institutions in Boston, one a VA hospital (VA Boston) and the other a non-VA hospital (Brigham and Women’s Hospital). Atherosclerosis risk factors, lesion characteristics, and outcomes of death, repeat revascularization, and limb amputation were assessed by review of the chart and national death indices. The hazard ratio and 95% confidence interval (HR, 95%CI) of death and adverse limb events for VA versus non-VA patients were assessed by Cox proportional hazard models. Results: Of the 203 subjects, 88 were VA patients and 115 were non-VA patients and 254 limbs were revascularized. VA and non-VA patients had a similar mean age (68 vs 68 years, p=0.74), and aspirin and statin use were over 90% in both groups. VA patients had a higher prevalence of diabetes (59% vs 41%, p=0.011) and current smoking (36% vs 18%, p=0.006). The prevalence of limbs with critical limb ischemia was similar (VA: 20% vs Non-VA: 17%, p=0.51), but limbs in VA patients were more likely to have TASC C or D lesions (57% vs 43%, p=0.028), and lesions > 200mm in length (44% vs 31%, p=0.044). Over an average 5.1 years follow-up, 96 patients died and 82 limbs required repeat revascularization. Compared to non-VA patients, VA patients had similar risks of death (HR=0.91, 95%CI=0.55, 1.49) and repeat revascularization (HR=1.1, 95%CI=0.67, 1.75). 17 limbs required subsequent surgical revascularization and 16 limbs had minor or major amputation with similar rates in both groups. Multivariable models showed similar results. Conclusion: In this comparison, VA patients having SFA endovascular revascularization had a higher prevalence of some atherosclerosis risk factors and more complex lesion characteristics, but similar long-term outcomes over an average 5 years.