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Comparing Major Adverse Limb Events in Claudicants with Complete, Partial, and Non-Adherence to Pre-Operative
Richard Shi1, Nicholas Bulatao1, Rupak Mukherjee1
1Division of Vascular Surgery, Medical University of South Carolina, Charleston SC.
Journal of Vascular Surgery
|July 22, 2026
Summary
Complete adherence to guideline-directed care (GDC) before surgery significantly reduces major adverse limb events (MALE) in claudicants. Partial adherence offers no significant benefit, highlighting the importance of full GDC for long-term risk mitigation.
Area of Science:
- Vascular Surgery
- Limb Salvage
- Interventional Cardiology
Background:
- Guideline-directed care (GDC) for claudicants includes optimal medical therapy (OMT) and supervised exercise therapy (SET).
- Surgery is recommended for severe lifestyle-limiting symptoms unresponsive to GDC.
- Many claudicants undergoing intervention have not completed full pre-operative GDC.
Purpose of the Study:
- To investigate the impact of pre-operative guideline-directed care (GDC) adherence on two-year major adverse limb events (MALE) in claudicants.
- To compare outcomes between complete, partial, and non-adherence to GDC.
- To assess the protective effect of GDC on MALE after intervention.
Main Methods:
- Retrospective analysis of 258 claudicants undergoing open surgery or endovascular intervention (2016-2023).
- GDC adherence defined by documentation of severe symptoms, OMT, and exercise therapy completion.
- Two-year MALE (major amputation or reintervention) as the primary outcome, analyzed using Kaplan-Meier and Cox regression.
Main Results:
- 12.8% had complete GDC adherence, 73.3% partial, and 13.9% non-adherence.
- Two-year MALE-free survival was 87.9% for complete adherence, 76.7% for partial, and 66.6% for non-adherence (p < 0.01).
- Complete adherence significantly decreased MALE risk (HR 0.24), while partial adherence did not (HR 0.99).
Conclusions:
- Complete adherence to pre-operative GDC is protective against two-year MALE in claudicants undergoing intervention.
- Partial adherence to GDC may not provide similar protection against MALE.
- Improving pre-operative GDC adherence is crucial for long-term risk mitigation and preventing complications in claudicants.
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