Multicenter Outcomes of Peripheral Vascular Interventions in Patients with Active Cancer.

Abstract

Objectives: Cancer is typically associated with venous thrombosis, but its impact on patients undergoing peripheral vascular interventions (PVI) for concomitant peripheral arterial disease (PAD) remains unclear. This multicenter study examines the characteristics of patients with active cancer and their outcomes after PVI.

Methods: Institutional vascular quality initiative (VQI) PVI data from 3 tertiary care centers (2019-2023) were combined and expanded through a retrospective chart review to include the presence and types of cancer. All adult patients undergoing endovascular intervention for PAD, including those with claudication, chronic limb-threatening ischemia (CLTI), and acute limb ischemia (ALI), were included. The primary outcome was the composite of major amputation or mortality at 4 years in patients with cancer compared to those without. Additional long-term outcomes included reintervention, mortality, and major amputation at both 1 and 4 years. Secondary outcomes included perioperative outcomes.

Results: A total of 3,072 patients were included. The incidence of active cancer was 2.2% (N=68). Lung cancer was the most common, affecting 30.9% (N=21) of patients. 53% (N=36) presented with advanced stages (3/4) irrespective of cancer type. Patients with cancer were less likely to have diabetes. There was no significant difference in indication, but patients with cancer were more likely to get treated for aortoiliac disease and undergo stenting. Patients with cancer had a higher incidence of distal embolization (4.4% vs 0.6%, P=0.012) and perioperative major amputation (4.4% vs 1.3%, P=0.046). Kaplan-Meier analysis showed significantly higher mortality or amputation in patients with cancer up to 4 years (63% vs 35.1%, P<0.001). Late outcomes in patients with cancer were driven by significantly higher mortality (52.2% vs. 28.3%, p<.001) rather than adverse limb events (amputation: 14.7% vs. 11.4%, p=.50; reintervention:47.8% vs. 48.3%, p=.80). Regression analysis demonstrated independent association of cancer with the composite outcome of mortality or major amputation (aHR=2.24 [1.61-3.10]).

Conclusion: Active cancer affects a small proportion of patients undergoing PVI but has a significant impact on perioperative limb outcomes and long-term survival. This multicenter collaboration, combining registry data and EMR review, can shed light on less common risk factors affecting lower extremity revascularization.