The Natural History of Peripheral Arterial Disease Following Lower Extremity Revascularization at a Single Institution

Abstract

Background

Peripheral artery disease (PAD) is widely prevalent, affecting more than 200 million people worldwide. However, the natural history of this disease process following lower extremity revascularization has not been fully delineated. We aimed to analyze this disease process with particular attention to subsequent interventions, wound complications, and mortality.

Methods

We conducted a prospective single-institution study that included patients who underwent lower extremity revascularization for PAD at our institute from December 2020 to December 2023. Patients were followed from the time of their index surgery through March 2024 or until they were lost to follow-up. Major events after the index revascularization were documented and analyzed.

Results

The study included 277 patients (35% female) with a mean age of 69 years. In this cohort, 21.3% of patients required postsurgical revascularization. Initial vascular complications occurred in 16% of patients, with 11% experiencing occlusion and 5% developing stenosis, while site-specific complications affected 10% of cases. Amputation was necessary in 11% of patients, primarily driven by worsening wounds (48%) and infection (23%). Secondary complications included bleeding events (9%), infection/wound dehiscence (5%), and thrombotic events (1%). The study revealed a 10% mortality rate, with patients surviving an average of 4.4 months post surgery.

Conclusion

We found that 21.3% of patients required at least one additional surgical revascularization of the ipsilateral leg, and the overall mortality rate during the study follow-up period was 10%. Knowledge of the risks of morbidity, mortality, and progression of disease can help vascular surgeons counsel patients undergoing lower extremity revascularization for PAD.