Incidence and risk factors associated with index hospitalization leg ischemia following endovascular abdominal aortic aneurysm repair.

Abstract

Although the incidence of index hospitalization leg ischemia after abdominal aortic aneurysm repair is low (1%-3%), it is a serious complication that merits investigation. Preoperative risk factors, such as demographics, medical history, and medication use (or a lack of) that may be associated with this complication are understudied. Our aim was to predict the factors that may be associated with the development of leg ischemia after endovascular repair in the index hospitalization period. All deidentified patient records from the Vascular Quality Initiative's abdominal aortic aneurysm endovascular repair registry (n = 76,166) were examined from January 1, 2003, to June 1, 2023. Patients without leg ischemia (n = 75,406) and those with it (n = 760) during the index hospitalization were separated into two groups. Demographic factors (eg, sex assigned at birth), medical history (eg, smoking status, hypertension), and medication use (eg, statin use) were compared between the two groups using univariate and multivariate analyses to examine association with leg ischemia. Comparisons with a P value of less than .05 were deemed significant. Over the study period, 1.0% of patients developed index hospitalization leg ischemia. Female sex assigned at birth (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.40-2.20; P < .001), current smoking status (OR, 1.72; 95% CI, 1.20-2.46; P = .003), hypertension (OR, 1.61; 95% CI, 1.16-2.22; P = .004), chronic obstructive pulmonary disease (OR, 1.29; 95% CI, 1.04-1.61; P = .020), ruptured aneurysm (OR, 2.06; 95% CI, 1.52-2.80; P < .001), postoperative myocardial infarction (OR, 2.06; 95% CI, 1.24-3.45; P = .006), iliac artery adjunct procedure (OR, 1.52; 95% CI, 1.16-1.99; P < .002), iliac limb end point in external iliac artery (OR, 2.56; 95% CI, 1.39-4.74; P < .003), intraoperative iliac/femoral artery thrombectomy (OR, 2.02; 95% CI, 1.15-3.56; P < .015), and intraoperative distal embolectomy (OR, 2.49; 95% CI, 1.29-4.81; P < .007) were significantly associated with leg ischemia. Preoperative statin use (OR, 0.79; 95% CI, 0.59 - 0.92; P = .008) was significantly associated with a decreased incidence of leg ischemia. Access site complications (hematoma/occlusion) had the greatest impact (OR, 18.65; 95% CI, 14.49-24.00; P < .001) on the development of leg ischemia. Certain factors such as female sex assigned at birth, current smoking status, ruptured aneurysm, iliac artery adjunct procedure, external iliac artery end point, and access site complication may be indicative of index postoperative leg ischemia. Preoperative statin use may decrease the risk of developing leg ischemia.