Lower Extremity Endovascular Interventions: Differences in Pre-operativ Variables and Outcomes Between Claudicants and Patients with CLI
Katelynn Ferranti, E. Lehman, Faisal Aziz.
Penn State University, Hershey, PA, USA.
Intermittent claudication (IC) and Critical Limb Ischemia (CLI) represent two ends of the wide spectrum of peripheral arterial disease (PAD). The number of endovascular interventions for lower extremity peripheral arterial disease has increased dramatically in past two decades. Most patients with IC and CLI receive endovascular interventions as a first line therapy. The purpose of this study is to compare the pre-operative variables and post operative outcomes between these patients.
The 2012 CEA –targeted American College of Surgeons (ACS-NSQIP) database and generalized 2015 general and vascular surgery ACS-NSQIP PUF were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing lower extremity endovascular interventions were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for hospital readmission within 30 days after surgery.
A total of 1,023 patients (Males 60%, Females 40%) were identified in NSQIP database, which underwent lower extremity endovascular interventions during the year 2012. Patients were divided into three groups: Intermittent claudication (42%), CLI with rest pain (CLI-RP) (20%) and CLI with tissue loss (CLI-TL) (38%). Patients with CLI-TL were more likely to be older, Hispanic, inpatient, transferred from other institutions, diabetic, functionally dependent and had wound infections, as compared to IC patients (p<0.05). Intra-operatively, patients with CLI-TR were considered a higher physiologic risk; higher ASA scores and had more tibial interventions when compared to IC group (<0.05). Post operatively, patients with CLI-TR had higher mortality (OR 3.36, CI 2-5.5, p<0.001), higher incidence of acute renal failure (OR 26.5 (CI 5.7-infinity) and higher incidence of sepsis (OR 12.67, CI 2.5-Infinity).
Patients with CLI-TL have significantly higher number of co-morbidities as compared to
IC patients. Patients with CLI-TL have higher ASA scores and receive more tibial interventions and have higher incidence of post operative mortality and acute renal failure.
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