Factors Associated with Amputation after Peripheral Vascular Intervention for Intermittent Claudication

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Public Health

Background:

• Intermittent claudication (IC) naturally has a low progression to major amputation (1-3%).
• The effect of endovascular therapies on IC's natural history is not well-documented.
• Evaluating amputation incidence and predictors post-peripheral vascular intervention (PVI) is crucial.

Purpose of the Study:

• To assess the rates of major and minor amputations following PVI for IC.
• To identify preoperative and intraoperative predictors of amputation after PVI in IC patients.

Main Methods:

• Retrospective analysis of 11,887 PVI procedures for IC from the Vascular Quality Initiative database (2003-2017).
• Examined major/minor amputation rates and amputation-free survival using Kaplan-Meier plots.
• Multivariable logistic regression identified predictors of amputation.

Main Results:

• Combined major and minor amputation rate was 1.08% (128/11,887 patients).
• Preoperative ankle-brachial index (ABI) <0.2 or >1.3 significantly increased amputation risk.
• Predictors for major amputation included symptomatic congestive heart failure (CHF), American Society of Anesthesiologists (ASA) class IV, and nonwhite race.
• Isolated tibial-level interventions increased odds of both major and minor amputations.

Conclusions:

• PVI does not appear to alter the natural history of IC concerning amputation rates.
• Patients with higher ASA class, symptomatic CHF, and isolated tibial interventions are at higher risk.
• Preoperative and intraoperative indicators can help predict amputation risk in IC patients undergoing PVI.