PMID- 37717639 OWN - NLM STAT- MEDLINE DCOM- 20231225 LR - 20231225 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 79 IP - 1 DP - 2024 Jan TI - Systemic immunosuppression does not affect revascularization outcomes in patients with chronic limb-threatening ischemia. PG - 111-119.e2 LID - S0741-5214(23)01982-1 [pii] LID - 10.1016/j.jvs.2023.09.015 [doi] AB - OBJECTIVE: Many patients with chronic limb-threatening ischemia (CLTI) have additional comorbidities requiring systemic immunosuppression. Few studies have analyzed whether these medications may inhibit graft integration and effectiveness, or conversely, whether they may prevent inflammation and/or restenosis. Therefore, our study aim was to examine the effect of systemic immunosuppression vs no immunosuppression on outcomes after any first-time lower extremity revascularization for CLTI. METHODS: We identified all patients undergoing first-time infrainguinal bypass graft (BPG) or percutaneous transluminal angioplasty with or without stenting (PTA/S) for CLTI at our institution between 2005 and 2014. Patients were stratified by procedure type and immunosuppression status, defined as >/=6 weeks of any systemic immunosuppression therapy ongoing at the time of intervention. Immunosuppression vs nonimmunosuppression were the primary comparison groups in our analyses. Primary outcomes included perioperative complications, reintervention, primary patency, and limb salvage, with Kaplan-Meier and Cox proportional hazard models used for univariate and multivariate analyses, respectively. RESULTS: Among 1312 patients, 667 (51%) underwent BPG and 651 (49%) underwent PTA/S, of whom 65 (10%) and 95 (15%) were on systemic immunosuppression therapy, respectively. Whether assessing BPG or PTA/S patients, there were no differences noted in perioperative outcomes, including perioperative mortality, myocardial infarction, stroke, hematoma, or surgical site infection (P > .05). For BPG patients, Kaplan-Meier analysis and log-rank testing demonstrated no significant difference in three-year reintervention (37% vs 33% [control]; P = .75), major amputation (27% vs 15%; P = .64), or primary patency (72% vs 66%; P = .35) rates. Multivariate analysis via Cox regression confirmed these findings (immunosuppression hazard ratio [HR] for reintervention, 0.95; 95% CI, 0.56-1.60; P = .85; for major amputation, HR, 1.44; 95% CI, 0.70-2.96; P = .32; and for primary patency. HR, 0.97; 95% CI, 0.69-1.38; P = .88). For PTA/S patients, univariate analysis revealed similar rates of reintervention (37% vs 39% [control]; P = .57) and primary patency (59% vs 63%; P = .21); however, immunosuppressed patients had higher rates of major amputation (23% vs 12%; P = .01). After using Cox regression to adjust for baseline demographics, as well as operative and anatomic characteristics, immunosuppression was not associated with any differences in reintervention (HR, 0.75; 95% CI, 0.49-1.16; P = .20), major amputation (HR, 1.46; 95% CI, 0.81-2.62; P = .20), or primary patency (HR, 0.84; 95% CI, 0.59-1.19; P = .32). Sensitivity analyses for the differences in makeup of immunosuppression regimens (steroids vs other classes) did not alter the interpretation of any findings in either BPG or PTA/S cohorts. CONCLUSIONS: Our findings demonstrate that patients with chronic systemic immunosuppression, as compared with those who are not immunosuppressed, does not have a significant effect on late outcomes after lower extremity revascularization, as measured by primary patency, reintervention, or major amputation. CI - Published by Elsevier Inc. FAU - Romary, Daniel J AU - Romary DJ AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Indiana University School of Medicine, Indianapolis, IN. FAU - Darling, Jeremy D AU - Darling JD AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. FAU - Patel, Priya B AU - Patel PB AD - Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. FAU - Dash, Siddhartha P AU - Dash SP AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Case Western Reserve School of Medicine, Cleveland, OH. FAU - Schermerhorn, Marc L AU - Schermerhorn ML AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. FAU - Lee, Andy M AU - Lee AM AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: alee10@bidmc.harvard.edu. LA - eng PT - Journal Article DEP - 20230917 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Humans MH - Chronic Limb-Threatening Ischemia MH - *Angioplasty, Balloon MH - Ischemia/diagnostic imaging/surgery MH - Vascular Surgical Procedures/adverse effects MH - Lower Extremity/surgery MH - Limb Salvage MH - Treatment Outcome MH - Immunosuppression Therapy MH - Retrospective Studies MH - Risk Factors MH - *Peripheral Arterial Disease/diagnostic imaging/surgery MH - Vascular Patency COIS- Disclosures M.S. is a consultant for Medtronic, Endologix, Cook, and Abbot. EDAT- 2023/09/18 00:41 MHDA- 2023/12/25 06:42 CRDT- 2023/09/17 19:14 PHST- 2023/07/14 00:00 [received] PHST- 2023/09/07 00:00 [revised] PHST- 2023/09/10 00:00 [accepted] PHST- 2023/12/25 06:42 [medline] PHST- 2023/09/18 00:41 [pubmed] PHST- 2023/09/17 19:14 [entrez] AID - S0741-5214(23)01982-1 [pii] AID - 10.1016/j.jvs.2023.09.015 [doi] PST - ppublish SO - J Vasc Surg. 2024 Jan;79(1):111-119.e2. doi: 10.1016/j.jvs.2023.09.015. Epub 2023 Sep 17.