Presentation and patterns of reinterventions after revascularization in patients with premature peripheral arterial
Anishaa Sivakumar1, Keyuree Satam2, Zhen Wu3
1Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, CT.
Insights
Patients with premature peripheral arterial disease (PAD) require more frequent reinterventions after lower extremity revascularization (LER). However, survival rates remain similar to older patients, despite demographic and socioeconomic disparities.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Health Outcomes Research
Background:
- Premature peripheral arterial disease (PAD), diagnosed at age 50 or younger, presents unique challenges in lower extremity revascularization (LER).
- Patients with premature PAD face a higher risk of major amputation compared to older individuals.
- Understanding reintervention rates in younger PAD patients is crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare the frequency of reinterventions after LER in patients with premature PAD versus older patients (60-80 years).
- To identify demographic, socioeconomic, and clinical differences between these patient groups.
- To evaluate long-term outcomes, including mortality, amputation, and major adverse limb events.
Main Methods:
- Retrospective review of 1274 patients undergoing LER for PAD.
- Comparison of clinical, procedural, and socioeconomic characteristics between premature PAD and older patient groups.
- Analysis of perioperative and long-term outcomes over a 5-year follow-up period.
Main Results:
- Premature PAD patients were more likely to be female, racial minorities, and have higher Distressed Communities Index scores.
- End-stage renal disease was more prevalent in the premature PAD group, while hypertension and hyperlipidemia were less common.
- Despite similar perioperative complications, premature PAD patients underwent significantly more frequent reinterventions over 5 years.
Conclusions:
- Patients with premature PAD require more frequent reinterventions following LER compared to older counterparts.
- Five-year survival and major adverse limb event-free survival were comparable between the premature and older PAD groups.
- Significant demographic and socioeconomic disparities in premature PAD warrant further investigation.
Objective:
Premature peripheral arterial disease (PAD) (age ≤50 years) has been shown to negatively impact the outcomes of lower extremity revascularization (LER). Patients with premature PAD have an increased risk of major amputation compared with older patients. The primary goal of this study is to compare the frequency of reinterventions after LER in patients with premature PAD to their older counterparts with common age of presentation (ie, 60-80 years).
Methods:
A retrospective review of consecutive patients undergoing LER for PAD in a single center was performed. Clinical, procedural, and socioeconomic characteristics were compared between patients with premature PAD and the older group. Perioperative and long-term outcomes were captured and compared including mortality, major amputation, reintervention rate and frequency, as well as major adverse limb events.
Results:
There were 1274 patients who underwent LER (4.3% premature, 61.8% age 60-80). Patients with premature PAD were more likely to be females of racial minorities. Notably, the mean Distressed Communities Index score was significantly higher in the premature PAD group compared with the older patients. Patients with premature PAD were significantly more likely to have end-stage renal disease but less likely to have hypertension, hyperlipidemia, and coronary artery disease compared with older patients. There was no significant difference in perioperative complications. After a mean follow-up of 5 years, patients with premature PAD were significantly more likely to undergo more frequent reinterventions compared with older patients. Kaplan-Meier curves showed similar overall survival and major adverse limb event-free survival between the two groups.
Conclusions:
Patients with premature PAD are likely to undergo more frequent reinterventions after initial LER and have similar 5-year survival curves compared with patients at least 20 years older. Demographic and socioeconomic differences impacting patients with premature PAD, even in this relatively underpowered institutional experience, are striking and warrant further investigation.
More Related Videos
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Peripheral Artery Disease I: Introduction
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Peripheral Artery Disease IV: Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management