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Progression to Chronic Limb-Threatening Ischemia After Index Revascularization for Claudication
Olamide Alabi1,2, Rae Rokosh2, Xinyan Zheng3
1Surgical and Perioperative Care, Atlanta VA Health Care System, Decatur, Georgia.
JAMA Surgery
|December 17, 2025
Summary
Black women with claudication had the highest progression to chronic limb-threatening ischemia (CLTI) after revascularization. Addressing disparities in care may improve outcomes for all patients with peripheral artery disease.
Area of Science:
- Vascular Surgery
- Health Disparities Research
- Health Services Research
Background:
- Claudication, a symptom of peripheral artery disease, can lead to chronic limb-threatening ischemia (CLTI) and amputation.
- Previous studies noted amputation disparities, but population-specific revascularization rates, CLTI progression post-revascularization, and pharmacotherapy use for claudication remain unknown.
Purpose of the Study:
- To investigate the impact of intersectional identity (race, ethnicity, sex) on claudication patient outcomes after revascularization.
- To analyze progression to CLTI, amputation rates, and mortality following lower-extremity revascularization procedures.
Main Methods:
- A national cohort study utilized the Vascular Quality Initiative (VQI) registry linked to Medicare data (2016-2019).
- Included patients with claudication undergoing index lower-extremity revascularization.
- Intersectional identity was the primary exposure; CLTI development within 180 days was the primary outcome.
Main Results:
- Among 10,012 patients, Black women exhibited the highest 180-day progression to CLTI (11.8%).
- Major amputation rates were also highest among Black patients (women: 0.8%, men: 0.7%).
- Black and Hispanic patients were more likely to have diabetes and dialysis; White men had higher statin use.
Conclusions:
- Black women face the highest risk of post-revascularization CLTI progression.
- Developing practice and policy standards for evidence-based claudication management is crucial for equitable outcomes.
- Addressing disparities in peripheral artery disease care is essential to reduce adverse events.
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