Area Deprivation Index Relationship to Patterns of Revascularization Among Chronic Limb-Threatening Ischemia Patients Presenting for Major Amputation: A Vascular Quality Initiative Study.

BACKGROUND

Social and environmental factors are known drivers of cardiovascular disease. The area deprivation index (ADI), derived from income, education, employment, and housing quality, provides a neighborhood-level measure of social vulnerability. This study evaluates ADI as a predictor of revascularization, amputation level, and postoperative complications in patients with chronic limb-threatening ischemia presenting for amputations.

METHODS

A retrospective analysis of the vascular quality initiative amputation registry (2012-2023) was performed. Patients were stratified by ADI quartiles: ≤25 (least deprived), 26-50, 51-75, and >75 (most deprived). The primary outcome was any preamputation revascularization (suprainguinal/infrainguinal bypass or peripheral vascular intervention [PVI]). Secondary outcomes included level of amputation and postoperative complications. Disease severity was defined using wound, ischemia, and foot infection ischemia grade. Multivariable logistic regression adjusted for clinical and demographic covariates.

RESULTS

Among 22,435 patients, those in the highest ADI quartile were younger (63 vs. 68 years, P < 0.001), more often active smokers (33.3% vs. 17.3%, P < 0.001), and more frequently ASA IV (43.5% vs. 36.8%, P < 0.001). They had more severe ischemia (31.4% vs. 28.5%, P = 0.03), underwent more suprainguinal bypass (7.5% vs. 3.4%) and PVI (10.5% vs. 6.9%), and fewer infrainguinal PVI (27.7% vs. 35.5%) (all P < 0.001); bypass rates were similar. Overall, 52% underwent some form of prior revascularization before amputation. High ADI patients more often received above-knee amputations (41.6% vs. 30.5%) and were less often discharged to rehabilitation (36.8% vs. 47.0%) (P < 0.001)

CONCLUSION

ADI is an independent predictor of disease severity, revascularization type, and postamputation outcomes. Integrating neighborhood-level deprivation into vascular care may improve equity in limb salvage and recovery.