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Sodium Glucose Cotransporter-2 Inhibitors are Not Associated with Amputation After Lower Extremity Revascularization

Uma D Alappan1, Ashwin K Chetty1, Warren Carter1

  • 1Yale University School of Medicine, New Haven, CT.

Annals of Vascular Surgery
|May 20, 2026
PubMed
Abstract

Insights

Sodium Glucose Cotransporter-2 inhibitors (SGLT2i) use is rising in diabetes patients undergoing lower extremity revascularization for peripheral arterial disease. This study found SGLT2i use did not increase amputation risk following revascularization.

Area of Science:

  • Vascular Surgery
  • Endocrinology
  • Pharmacology

Background:

  • Diabetes Mellitus (DM) is a major risk factor for Peripheral Arterial Disease (PAD) and Chronic Limb-Threatening Ischemia (CLTI).
  • Sodium Glucose Cotransporter-2 inhibitors (SGLT2i) offer cardiovascular and renal benefits but raise concerns regarding amputation risk in PAD patients.

Purpose of the Study:

  • To evaluate the association between SGLT2i use and outcomes in patients with DM undergoing Lower Extremity Revascularization (LER) for PAD.
  • To assess the safety and efficacy of SGLT2i in the context of PAD treatment.

Main Methods:

  • Retrospective cohort study of 2039 patients undergoing LER for PAD between 2013-2020.
  • Propensity score matching (3:1) compared outcomes between SGLT2i users and non-users.
  • Kaplan-Meier curves analyzed long-term outcomes including major amputation, mortality, and Major Adverse Limb Events (MALE)-free survival.

Main Results:

  • SGLT2i use increased significantly (0% to 10.3%) during the study period.
  • While SGLT2i users had higher perioperative return to OR rates, they experienced shorter hospital stays.
  • No significant differences were observed in perioperative or long-term amputation rates, all-cause mortality, or MALE-free survival between SGLT2i users and non-users.

Conclusions:

  • SGLT2i use is increasing among DM patients undergoing LER for PAD.
  • Current evidence suggests SGLT2i use is not associated with an increased risk of amputation after LER in this patient population.

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