PMID- 33548441 OWN - NLM STAT- MEDLINE DCOM- 20210927 LR - 20221207 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 74 IP - 2 DP - 2021 Aug TI - Impact of impaired ambulatory capacity on the outcomes of peripheral vascular interventions among patients with chronic limb-threating ischemia. PG - 489-498.e1 LID - S0741-5214(21)00139-7 [pii] LID - 10.1016/j.jvs.2020.12.088 [doi] AB - OBJECTIVE: Despite prior literature recommending against limb salvage in patients with poor functional status such as nonambulatory patients with chronic limb-threatening ischemia (CLTI), peripheral endovascular interventions continue to be carried out in this group of patients. Clinical outcomes following these interventions are, however, not well-characterized. METHODS: A retrospective review was conducted on all patients treated for CLTI in the Vascular Quality Initiative from September 2016 to December 2019. Logistic regression, Kaplan-Meier survival estimates, log-rank tests, and Cox regression analyses were used as appropriate to study outcomes. The primary outcomes were 30-day mortality and 1-year amputation-free survival. The secondary outcomes were in-hospital death, postoperative complications, 1-year freedom from major amputation, and 2-year survival. RESULTS: Of the 49,807 patients studied, 28,469 (57.2%) were ambulatory, 15,148 (31.0%) were ambulatory with assistance, 5395 (10.8%) were wheelchair bound, and 525 (1.1%) were bedridden. There was a 2-fold increase in the odds of 30-day death in patients who were ambulatory with assistance (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.77-2.34; P < .001) and wheelchair-bound patients (OR, 2.09; 95% CI, 1.74-2.51; P < .001), and a more than 6-fold increase in bedridden patients (OR, 6.28; 95% CI, 4.55-8.65; P < .001) compared with ambulatory patients. There was a significantly higher odds of postoperative complications in patients who were ambulatory with assistance or bedridden, but no difference with wheelchair-bound patients. Among ambulatory patients, the risks of major amputation and death within 1 year were only 10% and 12%, respectively, whereas that of bedridden patients were as high as 30% and 38%, respectively. A stepwise decrease in amputation-free survival from 81% with full ambulatory capacity to less than 50% (47.7%) in bedridden patients was observed. The risk of major amputation or death within 1 year was 35% higher for ambulatory with assistance (hazard ratio [HR], 1.35; 95% CI, 1.26-1.44; P < .001), 65% higher for wheelchair-bound (HR, 1.65; 95% CI, 1.51-1.79; P < .001) and 2.6-fold higher for bedridden (HR, 2.64; 95% CI, 2.17-3.21; P < .001) compared with ambulatory. A similar association was seen for 1-year freedom from major amputation and 2-year survival. CONCLUSIONS: Ambulatory impairment in patients with CLTI is associated with a significant increase in 30-day mortality and significant decrease in amputation-free survival after peripheral endovascular intervention. Bedridden patients had a 6-fold increase in the 30-day death rate, whereas their amputation-free survival dropped to less than 50% at 1 year. These risks should be considered during shared decision-making regarding management options for nonambulatory patients with CLTI. CI - Copyright (c) 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Naazie, Isaac N AU - Naazie IN AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, Calif. FAU - Arhuidese, Isibor AU - Arhuidese I AD - Division of Vascular Surgery, Department of Surgery, University of South Florida, Tampa, Fla. FAU - Zil-E-Ali, Ahsan AU - Zil-E-Ali A AD - Johns Hopkins Bloomberg School of Public Health, Johns Hopkins university, Baltimore, Md. FAU - Siracuse, Jeffrey J AU - Siracuse JJ AD - Boston University, School of Medicine, Boston, Mass. FAU - Malas, Mahmoud B AU - Malas MB AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, Calif. Electronic address: mmalas1@msn.com. LA - eng PT - Journal Article DEP - 20210204 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Amputation, Surgical MH - Chronic Disease MH - *Dependent Ambulation MH - *Endovascular Procedures/adverse effects/mortality MH - Female MH - Functional Status MH - Hospital Mortality MH - Humans MH - Ischemia/diagnosis/mortality/physiopathology/*therapy MH - Limb Salvage MH - Male MH - Middle Aged MH - *Mobility Limitation MH - Peripheral Arterial Disease/diagnosis/mortality/physiopathology/*therapy MH - Progression-Free Survival MH - Registries MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Time Factors OTO - NOTNLM OT - Ambulatory status OT - Amputation-free survival OT - Chronic limb threatening ischemia OT - Critical limb ischemia OT - Peripheral arterial disease EDAT- 2021/02/07 06:00 MHDA- 2021/09/28 06:00 CRDT- 2021/02/06 20:10 PHST- 2020/07/12 00:00 [received] PHST- 2020/12/23 00:00 [accepted] PHST- 2021/02/07 06:00 [pubmed] PHST- 2021/09/28 06:00 [medline] PHST- 2021/02/06 20:10 [entrez] AID - S0741-5214(21)00139-7 [pii] AID - 10.1016/j.jvs.2020.12.088 [doi] PST - ppublish SO - J Vasc Surg. 2021 Aug;74(2):489-498.e1. doi: 10.1016/j.jvs.2020.12.088. Epub 2021 Feb 4.