The Pattern Of Reinterventions After Revascularization In Patients With Premature PAD
Anishaa Sivakumar1, Keyuree Satam1, Haoran Zhuo2, Dana Alameddine3, Yawei Zhang4, Edouard Aboian3, Raul J. Guzman3, Cassius Iyad Ochoa Chaar3.
1Yale School of Medicine, New Haven, CT, USA, 2Division of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA, 3Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA, 4National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
OBJECTIVES: Premature peripheral arterial disease (PAD) (age ≤ 50) has been shown to negatively impact the outcomes of lower extremity revascularization (LER). Even though patients in that age group live longer, they are at increased risk of major amputation compared to older patients. The goal of this study is to compare the frequency of reinterventions after LER in patients with premature PAD to an older group (age 60-80).
METHODS: A retrospective review of consecutive patients undergoing LER for PAD was performed. Demographics, comorbidities, and procedural details were compared between patients with premature PAD and the older group. Perioperative as well as long-term outcomes were captured and compared including mortality, major amputation, reintervention rate, and frequency, as well as major adverse limb events (MALEs).
RESULTS: There were 1274 patients who underwent LER and 4.3% (n=55) had premature PAD. Premature PAD patients were more likely to be females (54.5% vs 33.7%, p=.002), African American (30.9% vs 14.3%, p<.001), or be of other non-white race (20% vs 9.1%, P<.001). Patients with premature PAD were significantly more likely to have ESRD (18.2% vs 7.6%, p=.006) and be active smokers (41.8% vs 29.8%, P=.012) but less likely to have hypertension (78.2% vs 92.9%, p<.001), hyperlipidemia (54.5% vs 76.4%, p<.001), and CAD (32.7% vs 55.2%, p=.001) compared to older patients. Aspirin use was lower in premature PAD patients (63.6% vs 75.7%, p=.046). Otherwise, medication management did not significantly differ between the groups. There was no significant difference in perioperative morbidity or mortality. After 3.2 years of follow up, patients with premature pad were significantly more likely to undergo 2 or 3 reinterventions compared to older patients but there was no difference in the mean number of reinterventions. There was a trend towards higher reintervention rate and major amputation in patients with premature PAD. Patients with premature PAD had higher MALEs compared to older patients that reached borderline statistical significance. (table)
CONCLUSIONS: Patients with premature PAD are more likely to undergo frequent reinterventions and have higher MALEs compared to older patients. Sex and race differences in this relatively underpowered institutional experience are striking and warrant further investigation.
| Age ≤ 50 N=55 (%) | Age 60-80 N=787 (%) | p-value | |
| Reintervention Rate | 29 (52.7) | 313 (39.9) | 0.061 |
| Frequency of Reinterventions | - | - | 0.005 |
| 1 | 11 (20) | 176 (22.4) | |
| 2 | 9 (16.4) | 72 (9.2) | |
| 3 | 7 (12.7) | 28 (3.6) | |
| 4+ | 2 (3.6) | 37 (4.7) | |
| Major Amputation | 7 (12.7) | 50 (6.4) | 0.07 |
| MALEs | 31 (56.4) | 336 (42.8) | 0.05 |
| Mortality | 10 (18.2) | 202 (25.7) | 0.213 |
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