The combination of abdominal aortic occlusion and inferior vena cava thrombosis is quite rare in clinical practice. We present the experience of treating a patient with chronic ischemia threatening limb loss, atherosclerotic occlusion of the infrarenal aorta combined with thrombosis of deep veins of the left lower limb, iliac veins on the left side, thrombus invasion into the inferior vena cava and the presenting 60-mm-flotating segment in it. After hospitalization and examination, a decision was made to perform a one-stage open intervention on the aorta and inferior vena cava. An aorto-femoral bifurcation alloprosthesis with reimplantation of the inferior mesenteric artery into the prosthesis main branche and open thrombectomy from the inferior vena cava were performed successfully. The course of the postoperative period was favorable. The main blood flow in the lower limbs was restored, rest ischemia of the left lower limb was suppressed. The control MSCT-angiography demonstrated that the thrombosis of iliac veins was occlusive, inferior vena cava was without thrombomasses. The patient was discharged in satisfactory condition in 11 days after the operation. The presented clinical case demonstrates high efficiency of the open treatment option in providing care to patients with combined pathology of the aorta and inferior vena cava.

When Circulatory Support Becomes a Double-Edged Sword - Lessons From a Case of Intra-Aortic Balloon Pump-Induced Limb Ischemia.

Hypertension, characterized by elevated blood pressure levels, remains a global health concern due to its association with cardiovascular complications, notably thrombosis. Thrombosis, the formation of blood clots within blood vessels, poses a significant risk for myocardial infarction, stroke, and limb ischemia, leading to adverse patient outcomes. Understanding the pathophysiological mechanisms underlying thrombosis in hypertension is crucial for developing effective preventive and therapeutic strategies. Hypertension induces structural and functional alterations in the vasculature, endothelium, and platelets, creating a prothrombotic milieu. Endothelial dysfunction, increased platelet activation, and alterations in coagulation factors contribute to the heightened thrombotic risk observed in hypertensive individuals. Biomarkers associated with thrombotic events, such as mean platelet volume, D-Dimer, and fibrinogen offer valuable insights into the pathogenesis of thrombosis and may serve as prognostic indicators for cardiovascular events in hypertensive populations. Investigating the impact of antihypertensive treatment on thrombotic risk is essential, as these medications exert pleiotropic effects on the vasculature and hemostatic system. By elucidating the intricate interplay between hypertension and thrombosis, this review aims to enhance our understanding of cardiovascular risk in hypertensive individuals and identify novel therapeutic targets for preventing thrombotic complications.

Ultrasound-Stimulated BMSCs Promote Regenerative Healing in Refractory Foot Ulcer by Paracrine Effect.

Acute non-traumatic ischemia of the lower limbs (ANLLI) remains a critical vascular emergency with a high risk of amputation and mortality if not diagnosed and treated promptly. The objective of this study was to analyze the epidemiological, clinical, and therapeutic aspects of ANLLI and to assess the outcomes of surgical and endovascular management in our institution. We conducted a retrospective analysis of 50 patients admitted for ANLLI at the Military Hospital of Marrakech between January 2018 and February 2022. Demographic characteristics, risk factors, clinical presentations, management strategies, and postoperative outcomes were collected and analyzed. The average age was 52 years (range 25–94), with a predominance of females (80%). Diabetes (78%), hypertension (40%), and smoking (30%) were the most common cardiovascular risk factors. Pain was the initial symptom in all cases, while pallor (84%), coldness (80%), paresthesia (30%), and paralysis (14%) were also observed. The left limb was more frequently affected (52%). All patients received initial anticoagulation, followed by surgical or endovascular intervention: embolectomy (60%), thrombectomy (20%), bypass (12%), and thrombolysis (8%). Postoperative complications occurred in 26% of cases, with an amputation rate of 10% and mortality rate of 1%. These results underline the necessity of early diagnosis, prompt revascularization, and rigorous postoperative monitoring to improve limb salvage and survival outcomes.

Large-scale genome-wide association studies have identified common genetic variants that predict the risk of peripheral artery disease (PAD). This study assessed whether a polygenic risk score (PRS) is associated with PAD and the incidence of major adverse limb events (MALE) independent of clinical risk factors in patients with established cardiometabolic disease. A genetic analysis was performed, pooling individual patient-level data from six TIMI trials. The association of a recently validated PAD PRS with prevalent PAD and the incidence of MALE (acute limb ischaemia, chronic limb-threatening ischaemia, major amputation, or peripheral revascularization) was assessed. A total of 68 816 patients were included in this analysis, with a median follow-up of 2.6 years. Of these, 5986 (8.7%) had known PAD at baseline. After adjusting for clinical risk factors, a higher PAD PRS was independently associated with a 15% greater odds of prevalent PAD (adjusted odds ratio per 1-SD: 1.15 [95% confidence interval 1.12-1.18], P < .0001), a magnitude of risk as strong as established clinical risk factors. A total of 577 patients experienced MALE during follow-up. A higher PAD PRS was associated with a 30% increased risk of MALE (adjusted hazard ratio per 1-SD: 1.30 [1.19-1.42], P < .0001). Adding the PAD PRS to clinical risk factors resulted in a statistically significant but modest improvement in discrimination (area under the curve went from 0.651 to 0.662 P < .0001). In a broad spectrum of patients with cardiometabolic disease, the PAD PRS is associated with an increased risk of PAD and the incidence of MALE beyond clinical risk factors; however, the improvement in discrimination was statistically significant but clinically modest.

BackgroundPeripheral artery disease (PAD), caused by atherosclerosis resulting in reduced blood flow in the lower extremities, impairs both skeletal muscle mass and function in humans, and its molecular mechanism is not clear. Recent studies have demonstrated that Nicotinamide phosphoribosyl transferase (NAMPT) influences skeletal muscle mass and function by modulating NAD+ levels and cellular Ca²⁺ homeostasis. However, its role in muscle fiber type transition remains to be elucidated.ResultsNAMPT is downregulated in ischemic skeletal muscle and CoCl2-treated C2C12 myotubes. NAMPT enhances the functional performance of ischemic limbs, reduces apoptosis, increases the formation of oxidative muscle fibers, and improves mitochondrial function. The cGMP‒PKG pathway is activated by NAMPT in ischemic limbs. Exogenous inhibition of cGMP-PKG signaling inhibits the formation of oxidative muscle fibers induced by NAMPT.ConclusionsNAMPT protects against ischemic limb injury via the cGMP‒PKG signaling pathway, suggesting that it is a promising therapeutic and predictive target for myopathy associated with PAD.Clinical trial numberNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13062-025-00705-z.

Background: Large-vessel arterial thromboembolism is a rare initial presentation of acute myelogenous leukemia (AML). Aortoiliac occlusion is exceptionally uncommon and has not been previously reported in association with acute myelomonocytic leukemia (AML-M4). Case Presentation: We present the first documented case of a 55-year-old female with AML-M4 who initially presented with recurrent respiratory infections and acute left leg ischemia, which responded to intravenous heparinization and femoropopliteal thromboembolectomy. However, progressive bilateral lower extremity ischemia revealed extensive thromboembolism involving the aortoiliac and bilateral femoropopliteal regions, requiring repeat thromboembolectomy and retrograde kissing balloon aortic angioplasty. Flow cytometry confirmed AML-M4 with CD13, CD33, CD11C and myeloperoxidase positivity. Her condition deteriorated due to multiple acute cerebrovascular infarcts, acute coronary thrombosis and sepsis, leading to her demise. Methods: A literature search of PubMed and Google Scholar (1980–2025) identified 51 cases of arterial thrombosis in AML. Results: Most patients were male (66%), with lower limb vessels (44%) as the most frequently affected sites. Acute promyelocytic leukemia (AML-M3) was the most common subtype. Management varied, including chemotherapy, anticoagulation and surgical or endovascular interventions. Conclusion: The management of arterial thrombosis in AML is complex due to the competing risks of thrombosis, hemorrhage and infection. Early leukemia identification and timely chemotherapy initiation must be carefully balanced against the risks of cytopenias and immunosuppression in these critically ill patients. Keywords: Arterial thrombosis, acute myeloid leukemia, coronary, cerebrovascular, limb ischemia, aorta

Abstract A 54-year-old male, a smoker, and on treatment for systemic hypertension, presented with nonlimb-threatening acute limb ischemia of the right upper limb. Evaluation revealed mural aortic arch thrombus. As the patient was not willing to undergo any interventional procedures, he was started on anticoagulation. After 3 months, there was complete resolution of the thrombus and his symptoms.

Background: Chronic kidney disease is a significant global health burden due to its high incidence and the risk of progression to end-stage renal disease (ESRD), cardiovascular disease, and premature death. Hemodialysis is a common kidney replacement therapy used for patients with ESRD with vascular access surgery crucial. Objectives: This study aims to evaluate the early and mid-term results of vascular access surgery. Subjects and Methods: A retrospective, descriptive case series study. At the TVS Department, Gia Dinh People's Hospital, from January 2020 to December 2022 were included. Results: The study involved 160 patients. Among the 125 patients had been follow up postoperation. The average age was 57 ± 14.5 years. Hypertension in 96.7%, diabetes in 44.7%, heart failure in 18.7%, and 10.6% had other comorbidities. Early results showed access occlusion in 18/141 cases (12.8%). Complications included 3.5% seroma and 2.1% distal limb ischemia syndrome. 77.3% with mature fistulas. Mid-term results showed 3.7% fistula occlusion during hemodialysis, and only 1 case experienced distal limb ischemia syndrome requiring ligation. 6.4% need to support from balloon dilation or branch ligation. Conclusion: Atrioveneous fistula for hemodialysis in ESRD patients has shown good results based on individual clinical examination and preoperative vascular ultrasound.

Cannulation for peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) can lead to severe local complications. This study evaluated site-specific complications between percutaneous and surgical cannulation techniques for femoro-femoral V-A ECMO, focusing on site bleeding, infection, and limb ischemia. We conducted a single-center retrospective cohort study of adult patients who received femoro-femoral V-A ECMO either by percutaneous or surgical technique at a tertiary center. Cannulation-site complications were assessed from cannulation to post-decannulation. Risk factors for site bleeding, infection, and limb ischemia within 90 days of cannulation were analyzed using logistic regression. Among 384 patients (22.4% female), 181 (47.1%) underwent percutaneous, and 203 (52.9%) underwent surgical cannulation. Percutaneous cannulation was associated with significantly fewer patients experiencing site bleeding (29.3% vs. 40.9%, p = 0.02) and infection (8.3% vs. 31.0%, p < 0.001), with no significant difference in limb ischemia (11.6% vs. 15.3%, p = 0.29). 90-day survival was similar between groups (43.6% vs. 49.8%, p = 0.81). Multivariable logistic regression identified surgical cannulation as an independent risk factor for site bleeding (OR 2.39, 95% CI 1.43-3.98; p < 0.001) and infection (OR 5.47; 95% CI 2.47-12.12; p < 0.001). Limb ischemia was not significantly associated with the cannulation technique but with two other modifiable factors at cannulation: absence of distal perfusion catheterization and larger arterial cannula size. Percutaneous cannulation was associated with significantly fewer patients experiencing site bleeding and infection compared to surgical cannulation. Limb ischemia was not associated with the cannulation technique but was influenced by two other modifiable factors at cannulation: distal perfusion catheterization and arterial cannula size.

Acute limb ischemia (ALI) is one of the most common arterial emergencies and is associated with a high risk of limb loss, morbidity, and mortality. Among endovascular techniques, catheter-directed thrombolysis (CDT) is the most widely used, though it presents limitations related to slow thrombus resolution and bleeding risk. Pharmacomechanical thrombectomy (PMT) has emerged as a faster and potentially more effective alternative. However, the comparative efficacy and safety of these two modalities remain a matter of debate. A systematic review and meta-analysis was conducted by searching PubMed and EMBASE databases to identify studies directly comparing PMT and CDT. Outcomes assessed included technical success, procedural complications, primary patency, limb salvage, and survival. Pooled analyses were performed using a random-effects model (OR; 95% CI). Four retrospective observational studies met the inclusion criteria, comprising a total of 607 patients (163 treated with PMT and 444 with CDT). Baseline demographics, comorbidities, and clinical limb presentation were similar, although more recent studies reported a higher prevalence of IIB Rutherford class ischemia in the PMT group. No differences were found in technical success OR 0.69 (95% CI: 0.16-3.03, P=0.62). At 30 days, there were no significant differences in limb loss rate OR 1.22 (95% CI: 0.66-2.27, P=0.52) and mortality OR 1.17 (95% CI: 0.59-2.31, P=0.65). At 12 months, no differences were observed in primary patency OR 1.84 (95% CI: 0.57-5.96, P=0.31), freedom from limb loss OR 1.20 (95% CI: 0.59-2.45, P=0.62), or freedom from all-cause death OR 1.53 (95% CI: 0.74-3.13, P=0.25). Adverse events such as distal embolization and acute kidney injury occurred more frequently in PMT group, with OR 2.09 (95% CI: 1.22-3.59, P=0.007) and OR 4.77 (95% CI: 1.85-12.30, P=0.001), respectively. Bleeding complications were slightly lower in the PMT group but did not reach statistical significance (P=0.67). Hospital stay was significantly shorter in the PMT group (MD -1.27 days; 95% CI: -1.84 to -0.70, P<0.001). PMT and CDT appear to provide comparable early and mid-term outcomes in the treatment of ALI. While PMT was associated with more periprocedural complications, it may offer advantages in selected cases requiring rapid revascularization. No clear superiority emerged between the two approaches. Considering the current limited evidence base, further high-quality prospective studies are warranted to define the optimal endovascular strategy and assess long-term effectiveness.

Background: Coral reef atherosclerosis of the renovisceral aorta leads to end-organ and extremity malperfusion due to ischaemia and/or embolic events. Those mostly female patients typically present with renovascular hypertension, chronic mesenteric ischaemia, and symmetric peripheral artery disease of all stages, including critical limb ischaemia. Mortality and morbidity are high in open surgery. Materials and methods: Here we describe step by step the individually designed endovascular solutions with multiple arterial accesses using stentgrafts and open stents in 8 consecutive patients. Results: All patients survived, acute renal failure occurred in 1 case, otherwise uneventful inhospital courses. Patients were followed over 25 (7-56) months with durable results. Conclusions: Endovascular treatment of coral reef aorta leading to aortic stenosis or occlusion in the renovisceral segment is feasible in most cases using multiple arterial accesses with good functional results, low mortality and morbidity and durable results.

BACKGROUNDStem cell therapy has emerged as a promising approach for treating critical limb ischemia (CLI), a condition caused by atherosclerosis that results in reduced blood flow and limb necrosis. However, the underlying therapeutic mechanisms involving factors secreted from stem cells are still in the early stages of exploration. This study focuses on investigating the tissue regenerative effects of interleukin-8 (IL8) secreted from cell spheroids.METHODSHuman adipose-derived stem cells (hASCs) were cultured on FGF2-tethered surfaces to form spheroid (FECS-Ad). A murine CLI model was established through femoral artery dissection, followed by the injection of various treatments, including PBS, hASC, FECS-Ad, IL8-silenced FECS-Ad, and recombinant IL8.RESULTSComparative analyses revealed that FECS-Ad injection resulted in a higher percentage of salvaged limbs, but these effects were attenuated when IL8 was silenced in FECS-Ad. Immunofluorescence staining, flow cytometry analysis and RT-qPCR of M1 and M2 macrophage markers demonstrated that IL8 has the ability to polarize macrophages to M2 type. Notably, FECS-Ad injection reduced apoptotic markers (caspase 8 and TUNEL) in ischemic tissues, whereas IL8 knockdown in FECS-Ad increased the proportion of apoptotic cells. FECS-Ad injected tissues showed larger regenerating muscle fibers with centrally located nuclei. Knockdown of IL8 in FECS-Ad decreased the area and size of regenerating muscle fibers.CONCLUSIONSOur findings underscore the dual role of IL8 in safeguarding muscle tissues from degeneration and orchestrating immunomodulatory effects by finely tuning tissue inflammation and macrophage polarization. This study highlights IL8 as a pivotal paracrine factor contributing to tissue regeneration in the context of stem cell therapy for CLI.

BackgroundThis study investigated the clinical characteristics of in-hospital cardiac arrest (IHCA) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock and assessed the related in-hospital and post-discharge mortality.MethodsThis study included 148 patients with AMI complicated by cardiogenic shock who were admitted to the Cardiac Critical Care Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University between September 1, 2021 and July 31, 2024. Study participants were divided into two groups according to the occurrence of IHCA (IHCA group, n = 62 and control group, n = 86). The primary endpoint was in-hospital mortality, whereas secondary endpoints included in-hospital complications (e.g., ischemic stroke, hemorrhagic stroke, gastrointestinal bleeding, and lower limb ischemia), 30-day post-discharge mortality, and 1-year post-discharge mortality. The association between IHCA and in-hospital mortality was assessed by Cox regression analysis, and post-discharge mortality risks were evaluated by modified Poisson regression analysis.ResultsIHCA was associated with significantly higher in-hospital mortality (61.3% vs. 29.8%, P < 0.001), 30-day mortality (67.7% vs. 39.3%, P = 0.001), and 1-year mortality (71.0% vs. 40.5%, P = 0.001) compared with the control group. Cox regression analysis showed that IHCA increased the risk of in-hospital mortality [hazard ratio [HR] 2.064, 95% confidence interval [CI] 1.180–3.609, P = 0.011]. The relative risks of death within 30 days and 1 year post-discharge were 1.606 (95% CI 1.172–2.201, P = 0.003) and 1.644 (95% CI 1.216–2.222, P = 0.001), respectively. IHCA patients with non-reversible cardiac arrest had a higher 30-day mortality risk [relative risk (RR) 1.599, 95% CI 1.118–2.286, P = 0.010] than those with reversible cardiac arrest, although no significant difference was observed in the risk of 1-year mortality (RR 1.369, 95% CI 0.975–1.922, P = 0.070).ConclusionsIHCA increases in-hospital, 30-day, and 1-year mortality risks in patients with AMI complicated by cardiogenic shock. Non-reversible cardiac arrest notably increases the risk of death within 30 days post-discharge.

Infection of vascular grafts after aortic revascularization surgery is a serious complication with high morbidity and mortality. This systematic review and meta-analysis aims to determine reinfection incidence in patients undergoing surgical intervention for infected aortic bypass grafts and identify key risk factors in the literature. This systematic review and meta-analysis followed PRISMA guidelines. Three electronic databases, PubMed/MEDLINE, Scopus, and Web of Science were used to search studies published after January 1, 2000, that assessed reinfection rates following surgical intervention for infected aortic bypass grafts. Random-effects meta-analysis was performed to calculate pooled incidence of major outcomes. Our systematic review included 30 studies with a total of 2,341 patients. Overall reinfection rate was 12.7% (95% CI: 8.6%-16.9%). In terms of morbidity 34.1% had acute kidney injury, 23.8% needed amputation, and 29.4% developed acute limb ischemia. The 30-day mortality rate was 27.8% (95% CI: 13.2%-42.4%).The medical approach to treatment varied significantly, however, the majority involved total removal of the infected prosthesis. The main microorganisms isolated in primary infections were mostly Staphylococcus and Enterococcus species, with a notable representation of gram-negative bacteria. Reinfection rates after surgical treatment of infected aortic bypass grafts were relatively high and constitute a challenge of high clinical impact. This is further demonstrated by the high 30-day mortality rate. The significant variation in treatment approaches observed above also highlights the lack of formalized management protocols. Further studies are needed to determine the best surgical approach and patient-related risk factors to optimize outcomes in this difficult population.

Percutaneous Fogarty thrombectomy is a novel and potentially less invasive alternative to surgical thrombectomy for the treatment of patients with acute limb ischemia (ALI). This study aimed to evaluate the effectiveness of percutaneous thrombectomy versus conventional surgical thrombectomy with respect to amputation-free survival (AFS) and periprocedural complications in patients with ALI. We conducted a multicenter, retrospective, observational study enrolling 148 patients with ALI who underwent percutaneous or surgical thrombectomy (percutaneous group, 44 patients; surgical group, 104 patients) between January 2014 and October 2023. The primary outcome measure was the 12-month AFS rate, and the secondary outcome measure was periprocedural complications. Propensity score matching analysis was applied to minimize baseline differences and to compare outcomes between the groups. After propensity score matching, 30 and 60 patients were allocated to the percutaneous and surgical groups, respectively. The 12-month AFS was not significantly different between the groups (percutaneous group: 73.6% vs. surgical group: 53.3%, log-rank p=0.16). The incidence of major access-site bleeding, vessel perforation, wound infection, and delayed wound healing was not significantly different between the 2 groups (all p>0.05). The current study revealed that AFS rate and perioperative complications were not significantly different between patients with ALI undergoing percutaneous and surgical thrombectomy.Clinical ImpactPercutaneous Fogarty thrombectomy is a novel and potentially less invasive alternative to surgical thrombectomy for the treatment of patients with lower extremity acute limb ischemia; however, its effectiveness and safety have not yet been fully established. This multicenter retrospective analysis found that amputation-free survival rates were not significantly different in patients undergoing the percutaneous thrombectomy, compared with those undergoing the conventional surgical thrombectomy. Future studies with a larger sample size are warranted to confirm the generalizability of the findings.

Introduction: Peripheral vascular intervention (PVI) is increasingly used for the treatment of peripheral arterial disease (PAD) with intermittent claudication (IC). Large, real-world studies of PVI are needed. Research Question: What is the comparative effectiveness and costs of elective PVI compared to no PVI among patients with PAD and IC? Methods: We conducted a 1:1 propensity-matched retrospective cohort analysis of insured individuals ≥18 years with incident PAD diagnosis and IC without acute or chronic limb ischemia from 1/1/16-9/30/23 in OptumLabs ® Data Warehouse. Patients receiving elective PVI were matched to those who did not receive PVI based on 17 variables, including demographics, prior amputations, comorbidities, medications, and year. Patients with rest pain, ulcer, gangrene, and acute limb ischemia (ALI) were excluded. The primary outcome was major adverse limb events (MALE), a composite of new major amputations, conversion to chronic limb threatening ischemia (CLTI), and new ALI at 12 months. Secondary outcomes were probability of subsequent PVI after a 30-day delay and total costs of care. Results: Among 26,726 propensity-matched patients, mean age was 70.4 years, 41% were women. PVI was associated with a higher risk of MALE (hazard ratio [HR] 2.10, 95% CI 1.95-2.27), including major amputations, conversion to CLTI, and new ALI ( Table ). Among the 13,363 patients who received PVI, 3,479 (26.0%) received a repeat procedure within the next 12 months, compared to 61 (0.46%) who did not (HR 66.1, 95% CI 51.3-85.1). PVI was associated with higher mean costs of care over 12 months compared to no PVI ($44,951 [SD $44,342] vs $26,626 [SD $43,811]). Conclusion: In this large real-world study, elective PVI for PAD with IC was associated with increased major adverse limb events and subsequent PVIs along with an average $18,000 higher total cost of care at 12 months. These findings suggest that the role of PVI in treatment of IC should be re-assessed.

Introduction: Peripheral arterial disease (PAD) complicated by acute limb ischemia (ALI) is a vascular emergency. The emergence of COVID-19, with its known prothrombotic effects, has raised the likelihood of worse vascular outcomes in this vulnerable cohort. This study aims to evaluate how concurrent infection with COVID-19 impacts in-hospital mortality among patients hospitalized with both PAD and ALI using a nationally representative database. Methods: We used the HCUP-NIS dataset (2020–2022) to identify adult hospitalizations with both peripheral arterial disease and acute limb ischemia using ICD-10 codes. COVID-19 status and in-hospital mortality were recorded. Survey-weighted logistic regression was used to adjust for age, sex, race, income, and Charlson Comorbidity Index (CCI). Results: 14,959 patients were admitted with ALI and PAD. Out of this 789 had COVID-19 (5.27%) and the remaining 14,170 (94.73%) were negative. In-hospital mortality was 27.76% in patients with COVID-19 compared to 6.37% in COVID negative patients (p &lt; 0.001). After adjusting for age, race, sex, income, and comorbidity burden using the CCI, COVID-19 remained a strong independent predictor of in-hospital death (p &lt; 0.001). Increasing age and higher CCI scores were also independently associated with mortality. We evaluated calendar-year trends in in-hospital mortality among patients with PAD, ALI, and concurrent COVID-19 infection from 2020 to 2022. After adjusting for co-variates, there was no statistically significant difference in mortality across the three years. Compared to 2020, the adjusted odds of in-hospital death were not significantly different in 2021 (p = 0.959) or in 2022 (p = 0.256).

Background: Heart failure (HF) is a known risk factor for adverse outcomes in cardiovascular diseases, but its impact on acute limb ischemia (ALI) outcomes remains underexplored. This study evaluates the effect of HF on inpatient mortality, amputation rates, length of stay (LOS), and hospital costs in ALI patients using a nationally representative cohort. Methods: We queried the National Inpatient Sample (2016–2020) and identified 44,913 ALI-related admissions. After excluding patients &lt;18 years and records with missing key variables, 37,026 adult cases remained, of which 8,489 had a diagnosis of HF. Propensity score matching (PSM; 1:1 nearest neighbor) was performed using 35 clinical and demographic variables, yielding a final matched cohort of 16,978 patients (8,489 with HF and 8,489 without HF). Primary outcomes were inpatient mortality and major amputation. Secondary outcomes included LOS and total hospitalization cost (TOTCHG). Logistic regression assessed binary outcomes, Wilcoxon rank-sum tests compared continuous variables, and Kaplan-Meier curves estimated survival differences. Results: In the matched cohort of 16,978 ALI patients (mean age 69.5 years, 46.8% female), racial/ethnic composition was predominantly White (72.3%), followed by Black (14.6%), Hispanic (8.0%), Asian or Pacific Islander (1.6%), Native American (0.6%), and Other (2.9%). Patients with HF had significantly higher inpatient mortality than those without HF (11.1% vs. 8.9%; OR 1.33, 95% CI 1.21–1.45, p &lt; 0.001). Major amputation rates were similar between groups (9.0% vs. 8.7%; OR 1.06, 95% CI 0.93–1.20, p = 0.387). HF patients had a longer median LOS (8 days [IQR: 5–14] vs. 6 days [IQR: 3–11]; p &lt; 0.001) and higher median total hospitalization cost ($111,794 [IQR: $67,813–$233,700] vs. $98,022 [IQR: $57,040–$194,022]; p = &lt;0.001). Kaplan-Meier survival analysis showed a trend toward worse inpatient survival in the HF group (log-rank p = 0.055). Conclusions: In patients hospitalized with ALI, HF is associated with significantly increased inpatient mortality, longer hospital stays, and higher costs. These findings highlight the critical need for proactive HF management in ALI to reduce mortality and healthcare burden.