Annals of vascular surgery · 2026
Anatomic Level as a Modifier of Racial/Ethnic Disparities in Chronic Limb-Threatening Ischemia: Outcomes After First-Time Endovascular Revascularization.
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Mallepally Adarsh, Komorowski Daniel, Newton Daniel H
Аннотация
PURPOSE: Racial and ethnic disparities in chronic limb-threatening ischemia (CLTI) outcomes are well documented, but whether these disparities vary by anatomic level of endovascular intervention remains unclear. We evaluated racial and ethnic differences in limb outcomes following endovascular revascularization for CLTI stratified by intervention level.
METHODS: We performed a retrospective cohort study using the TriNetX US Collaborative Network, including adults undergoing first-time lower extremity endovascular revascularization for CLTI between 2015-2024. Patients were stratified by intervention level: iliac, femoropopliteal, tibioperoneal, or combined femoropopliteal and tibioperoneal (multilevel). Propensity score matching balanced demographics and comorbidities across racial/ethnic cohorts. The primary outcomes were rates of 1-year major amputation and amputation-free survival (AFS). Outcome comparisons were reported as risk ratios (RR).
RESULTS: Among 14,786 patients, there were 3,071 iliac, 5,178 femoropopliteal, 2,363 tibioperoneal, and 3,718 multilevel interventions. After matching, Black patients demonstrated increased major amputation risk following iliac intervention (RR: 1.80, 95% CI: 1.13-2.88, p=0.012) and femoropopliteal intervention (RR: 1.83, 95% CI 1.39-2.41, p<0.001) compared with White patients. No significant differences in amputation were observed following tibioperoneal or multilevel interventions. Hispanic patients exhibited increased amputation risk only in the multilevel cohort (RR: 1.57, 95% CI: 1.02-2.40, p=0.037). Despite differences in amputation, AFS remained similar across racial and ethnic groups.
CONCLUSIONS: Racial and ethnic disparities in CLTI outcomes following endovascular revascularization varied by anatomic intervention level. Disparities were most pronounced after proximal interventions and attenuated in distal disease, suggesting anatomic disease pattern may modify inequities in limb outcomes after revascularization.
METHODS: We performed a retrospective cohort study using the TriNetX US Collaborative Network, including adults undergoing first-time lower extremity endovascular revascularization for CLTI between 2015-2024. Patients were stratified by intervention level: iliac, femoropopliteal, tibioperoneal, or combined femoropopliteal and tibioperoneal (multilevel). Propensity score matching balanced demographics and comorbidities across racial/ethnic cohorts. The primary outcomes were rates of 1-year major amputation and amputation-free survival (AFS). Outcome comparisons were reported as risk ratios (RR).
RESULTS: Among 14,786 patients, there were 3,071 iliac, 5,178 femoropopliteal, 2,363 tibioperoneal, and 3,718 multilevel interventions. After matching, Black patients demonstrated increased major amputation risk following iliac intervention (RR: 1.80, 95% CI: 1.13-2.88, p=0.012) and femoropopliteal intervention (RR: 1.83, 95% CI 1.39-2.41, p<0.001) compared with White patients. No significant differences in amputation were observed following tibioperoneal or multilevel interventions. Hispanic patients exhibited increased amputation risk only in the multilevel cohort (RR: 1.57, 95% CI: 1.02-2.40, p=0.037). Despite differences in amputation, AFS remained similar across racial and ethnic groups.
CONCLUSIONS: Racial and ethnic disparities in CLTI outcomes following endovascular revascularization varied by anatomic intervention level. Disparities were most pronounced after proximal interventions and attenuated in distal disease, suggesting anatomic disease pattern may modify inequities in limb outcomes after revascularization.