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Systemic immunosuppression does not affect revascularization outcomes in patients with chronic limb-threatening
Daniel J Romary1, Jeremy D Darling2, Priya B Patel3
1Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Indiana University School of Medicine, Indianapolis, IN.
Journal of Vascular Surgery
|September 17, 2023
Summary
Systemic immunosuppression did not significantly impact outcomes for patients undergoing lower extremity revascularization for chronic limb-threatening ischemia (CLTI). This includes graft patency, reintervention rates, and major amputation, regardless of procedure type.
Area of Science:
- Vascular Surgery
- Immunosuppression Therapy
- Chronic Limb-Threatening Ischemia (CLTI)
Background:
- Many patients with CLTI require systemic immunosuppression due to comorbidities.
- The impact of immunosuppression on lower extremity revascularization outcomes is not well-established.
- Potential effects include inhibition of graft integration or prevention of inflammation/restenosis.
Purpose of the Study:
- To evaluate the effect of systemic immunosuppression versus no immunosuppression on outcomes after first-time lower extremity revascularization for CLTI.
- To compare outcomes between bypass graft (BPG) and percutaneous transluminal angioplasty with or without stenting (PTA/S) procedures.
Main Methods:
- Retrospective analysis of 1312 patients undergoing first-time infrainguinal BPG or PTA/S for CLTI (2005-2014).
- Patients stratified by immunosuppression status (≥6 weeks of therapy at intervention).
- Primary outcomes: perioperative complications, reintervention, primary patency, limb salvage. Analyzed using Kaplan-Meier and Cox regression models.
Main Results:
- No significant differences in perioperative outcomes or 3-year outcomes (reintervention, primary patency, major amputation) for BPG patients on immunosuppression.
- For PTA/S patients, univariate analysis showed higher amputation rates in immunosuppressed group (23% vs 12%, P=.01).
- Multivariate analysis (Cox regression) found no significant association between immunosuppression and reintervention, major amputation, or primary patency for either BPG or PTA/S.
Conclusions:
- Systemic immunosuppression does not significantly affect late outcomes (primary patency, reintervention, major amputation) after lower extremity revascularization for CLTI.
- Findings hold true for both bypass graft and percutaneous transluminal angioplasty procedures.
- Immunosuppression status should not be a contraindication for revascularization in CLTI patients.
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