Premature Peripheral Arterial Disease Is Associated With Worse Outcomes in Patients Undergoing Infrainguinal Bypass and Endovascular Intervention

Few data exist to accurately describe the difference in characteristics, management, and outcomes of patients with premature peripheral arterial disease (PPAD), defined as patients <50 years old at the time of intervention. Our goal was to use Vascular Quality Initiative (VQI) data to investigate differences between PPAD patients and non-PPAD patients who had lower extremity vascular interventions. All VQI patients from the infrainguinal bypass and peripheral vascular intervention (PVI) modules between 2010 and 2015 were included. Patients were divided into two groups: <50 years old (PPAD group) and ≥50 years old (non-PPAD group). The patients’ demographics, comorbidities, procedure indications, and outcomes at long-term follow-up were compared. Outcomes analyzed included patency, limb salvage, symptom recurrence, need for reintervention, and survival. Long-term follow-up is defined in the VQI as 9 to 21 months. Data from 5411 PPAD patients and 99,630 non-PPAD patients were analyzed. PPAD patients were more commonly African American, female, and smokers at the time of the procedure (all P < .01). PPAD patients underwent infrainguinal bypass more frequently than non-PPAD patients did (29.1% vs 25.2%; P < .01). PPAD patients undergoing infrainguinal bypass had higher rates of postoperative revision (21.5% vs 13.2%; P > .001) and major amputation (9.6% vs 6.5%; P < .001; Table). For PPAD patients undergoing PVI, rates of major amputation were higher as well (6.6% vs 4.6%; P < .001; Table). On adjusting for significant comorbidities, medications, and previous interventions, PPAD patients were still found to have significantly increased odds of major amputation after infrainguinal bypass (odds ratio, 1.45; P < .004) and PVI (odds ratio, 1.57; P < .001). PPAD patients experienced higher rates of postoperative revision after infrainguinal bypass and major amputation after both infrainguinal bypass and PVI. Although limited data sets such as the VQI do not lend themselves to more discrete examination, it seems reasonable to avoid lower extremity intervention in PPAD patients until it is deemed urgent or emergent because of poorer outcomes in this group.TableInfrainguinal bypass and peripheral vascular intervention (PVI) outcomesVariableTotal cohort, No. (%)Non-PPAD, No. (%)PPAD, No. (%)P valueInfrainguinal bypass Postoperative revision4502 (16.9)4162 (13.2)340 (21.5)