Clinical and financial outcomes of endovascular versus open revascularization in acute limb ischemia

Although significant differences in chronic-limb threatening ischemia outcomes across revascularization strategies have been previously described, such analyses in acute lower-extremity ischemia are scarce. We identified associations of endovascular versus open lower-extremity revascularization with in-hospital mortality, major lower extremity amputation, and nonelective readmissions in a national cohort of patients with acute lower-extremity ischemia.

All nonelective adult (≥18 years) hospitalizations entailing revascularization for diagnoses of acute lower-extremity ischemia were ascertained in the 2012-2021 Nationwide Readmissions Database. Patients were stratified into endovascular and open cohorts. Multivariable regression models were developed to identify associations between operative approach and resultants including mortality, various perioperative complications, and nonelective readmission.

Of 277,440 hospitalizations, 49.8% and 50.2% were classified as endovascular and open, respectively. Inclusive of all hospitalizations within 90 days of primary discharge, the open group was associated with reduced odds of major amputation (adjusted odds ratio, 0.83; 95% confidence interval, 0.78-0.89). Relative to the endovascular group, the open group faced greater odds of in-hospital mortality (adjusted odds ratio, 1.25; 95% confidence interval, 1.17-1.33) and nonhome discharge (adjusted odds ratio, 1.82; 95% confidence interval, 1.76-1.87). Furthermore, open revascularization was linked to greater odds of intraoperative (adjusted odds ratio, 1.30; 95% confidence interval, 1.18-1.43), respiratory (adjusted odds ratio, 1.57; 95% confidence interval, 1.50-1.64), and infectious complications (adjusted odds ratio, 1.19; 95% confidence interval, 1.13-1.26).

Although endovascular revascularization appears linked with reduced risk of in-hospital mortality and complication, it is also associated with greater risk of amputation at 90 days postdischarge. Our study finds that open revascularization may optimize potential for limb preservation in suitable candidates with acute limb ischemia but portends greater perioperative morbidity and mortality.