Background
Premature peripheral artery disease (PAD), defined as ≤ 50 years of age, is associated
with poor outcomes following lower extremity revascularization (LER). However, the
specific characteristics and outcomes of this group of patients compared to those
at the common age undergoing revascularization have not been examined. The aim of
this study is to compare patients with early versus late onset premature PAD undergoing
LER focusing on major adverse limb events (MALEs).
Methods
All LER procedures (open and endovascular) in the Vascular Quality Initiative (VQI)
were reviewed. A histogram of patient age at the time of initial LER (no prior LER)
was used to define the common age, which included all patients within one standard
deviation of the mean. Characteristics and outcomes of patients with premature PAD
were compared to patients treated at the common age of presentation undergoing LER.
Results
A histogram of all patients undergoing LER was used to define 60 to 80 years as the
common age. Patients with premature PAD were more likely to be female, African American,
and Hispanic compared to patients at the common age. Patients with premature PAD were
also more likely to have insulin-dependent diabetes, be current smokers, on dialysis,
and be treated for claudication. Patients with premature PAD were less likely to have
Transatlantic Intersociety Consensus (TASC II) C or D disease and were less likely
to be on antiplatelets and statins. These differences were more pronounced in patients
with chronic limb-threatening ischemia (CLTI). Cox proportional hazards regression
demonstrated that premature PAD was independently associated with major adverse limb
events (MALEs) at 1-year for patients with claudication (HR:1.7, 95% CI:1.4–2.0) and
CLTI (HR:1.3, 95% CI:1.2–1.5) compared to patients 60 to 80 years of age.
Conclusions
Patients with premature PAD have significant differences in characteristics compared
to patients treated at the common age. Vascular providers should emphasize medical
therapy prior to LER given the lower rates of medical optimization and worse 1-year
MALEs in patients with premature PAD.
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Article Info
Publication History
Published online: August 01, 2022
Accepted:
July 7,
2022
Received:
February 26,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures: Carlos Mena-Hurtado is a consultant for Abbott, COOK, and Optum Labs.
Presented as a podium presentation at the Vascular and Endovascular Surgical Society Annual Winter Meeting 2022.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
