Do Ethnic Differences and TransAtlantic InterSociety Consensus Distribution Affect the Incidence of Lower Extremity Amputation?

There has been recent interest in ethnic differences with a wide variety of disease entities. Some evidence has suggested that particular ethnic populations may be more susceptible to severe manifestations of peripheral arterial disease. This study was initiated to better determine what if any factors affected a diverse ethnic population afflicted with critical limb ischemia (CLI). We reviewed all patients presenting with CLI from January 1, 2007, to December 31, 2007. CLI was defined as ischemic rest pain, nonhealing ulceration, or gangrene (Rutherford class 4 and 5) for which a major amputation was imminently required. All patients underwent conventional arteriography and if possible, an endovascular, open, or hybrid procedure for successful limb salvage. Multivariate logistic regression was used to determine any association between ethnic background and Rutherford class, comorbid conditions, TransAtlantic InterSociety Consensus II (TASC II) classification, runoff score, types of intervention (open, endovascular, or hybrid), prior and repeat procedures, death, and 1-year amputation-free survival (outcome). During this 1-year period, 148 patients presented with primary, secondary, or tertiary CLI. Of these, 58 patients (40%) were black, 57 (40%) were Latino, 28 (20%) were white, and ethnic background could not be determined in 5. There was no difference in clinical presentation among the three races. All groups had similar rates of TASC II D iliac disease; however, black patients had a higher prevalence of TASC II D femoropopliteal disease. Latino and white patients had a higher prevalence of TASC II D infrapopliteal disease. Primary patency rates among the ethnic groups remained similar at 1 year, however the Latino group displayed poorer patency after 1 year compared the black and white groups. All three ethnic groups had a similar 1-year amputation rate of 6.4%. There does not appear to be a significant difference among racial groups in clinical presentation. There are disparate lesion distributions among the three ethnic groups, with more severe TASC II D infrapopliteal disease in the Latino group, possibly affecting primary patency. There was no clear ethnic difference amongst the groups with regards to overall amputation rate.