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Outcomes Of Peripheral Vascular Interventions In Patients With Active Cancer
Elisa Caron, MD1, Shreef Said, MD
2, Hind Anan, MD
3, Yashashwini Sudina, MD
3, Dana Alameddine, MD
2, Rabih Chaer, MD
3, Marc Schermerhorn, MD
1, Cassius Ochoa Chaar, MD
2, Lars Stangenberg, MD
1.
1Beth Israel Deconess Medical Center, Boston, MA, USA,
2Yale University School of Medicine, New Haven, CT, USA,
3University of Pittsburgh, Pittsburgh, PA, USA.
Objectives: Cancer is typically associated with venous thrombosis but its impact on patients undergoing peripheral vascular interventions (PVI) for concomitant peripheral arterial disease (PAD) remains unclear. This multicenter study examines the characteristics of patients with active cancer and their outcomes after PVI.
Methods:Novel methodology combining vascular quality initiative (VQI) data and retrospective electronic medical record review was utilized. The institutional PVI from 3 tertiary care centers were combined (2019-2023) and expanded by retrospective review for the presence and types of cancer. Outcomes of patients with and without cancer were compared.
Results: A total of 3,072 patients were included. The incidence of active cancer was 2.2% (N=68). Lung cancer was most common, affecting 30.9% (N=21) of patients. 53% (N=36) presented with advanced stages (3/4) irrespective of cancer type. Patients with cancer were less likely to have diabetes. There was no significant difference in indication but patients with cancer were more likely to get treated for aortoiliac disease and undergo stenting. Patients with cancer had a higher incidence of distal embolization (4.4% vs 0.6%, P=0.012) and perioperative major amputation (4.4% vs 1.3%, P=0.046). Kaplan-Meier analysis showed significantly higher mortality or amputation in patients with cancer up to 4 years (63% vs 35.1%, P<0.001). (Figure 1) Late outcomes in patients with cancer were driven by significantly higher mortality (52% vs. 28%, p<.001) rather than adverse limb events (amputation: 15% vs. 11%, p=.80; reintervention (47.8% vs. 48.3%, p=.50).
Conclusion: Active cancer affects a small proportion of patients undergoing PVI but has significant impact on perioperative but not 4-year amputation. These data suggest that patients with cancer have higher perioperative limb related morbidity but similar limb related outcomes long-term. This multicenter collaboration combining registry data and EMR review can shed light on less common risk factors that affect revascularization.
Figure 1 : KM curves of Major Amputation or mortality in patients with active cancer compared to patients without.
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