228 - Anatomic Level as a Modifier of Racial/Ethnic Disparities in Chronic Limb-Threatening Ischemia: Outcomes After First-Time Endovascular Revascularization

Purpose: To evaluate racial and ethnic disparities in post-procedural outcomes after first-time endovascular revascularization for chronic limb-threatening ischemia (CLTI), stratified by anatomic level of intervention.

Materials and Methods: We conducted a retrospective, multi-center cohort study using the TriNetX database, identifying adults who underwent endovascular revascularization as a first-line intervention for CLTI from 2015-2024. Patients were stratified by treated arterial level (iliac, femoropopliteal, tibioperoneal). Within each stratum, we compared outcomes for Black vs White and Hispanic vs White patients, controlling for demographics and clinical covariates using 1:1 propensity-score matching. The primary outcome was 1-year incidence of major amputation. Secondary outcomes were rates of reintervention (endovascular or open), acute limb ischemia (ALI), and major adverse cardiovascular events (MACE), a composite of stroke, myocardial infarction, or all-cause death. Outcome comparisons were reported as risk ratios (RR) with 95% CIs.

Results: Among iliac interventions, after matching (n=418), Black patients had nearly double the risk of major amputation compared to their White counterparts (RR: 1.96, CI: 1.27–3.03, P=0.002. Similarly, in femoropopliteal interventions, Black patients (n=883) exhibited higher rates of major amputation (RR: 1.59, CI: 1.20–2.11, P=0.001) but lower all-cause mortality (RR: 0.77, CI: 0.62–0.96, P=0.022). Hispanic patients who received femoropopliteal intervention (n=336) had a lower incidence of MACE events (RR: 0.74, CI: 0.57–0.95, P=0.019). Among those who had tibioperoneal treatment, Hispanic patients (n=299) also exhibited fewer MACE events (RR: 0.74, CI: 0.57–0.95, P=0.019). Within the multilevel group who received both femoropopliteal and tibioperoneal interventions, Hispanic patients (n=420) demonstrated a higher risk of major amputation (RR: 1.60, CI: 1.13–2.26, P=0.007) and ALI (RR: 2.17, CI: 1.26–3.73, P=0.004) compared to White patients.

Conclusion: Across anatomic strata, disparities in post-procedural outcomes after CLTI concentrate in limb events, rather than systemic cardiovascular events, and vary by anatomic disease extent. Together, this suggests that post-acute limb care and distal perfusion likely drive much of the observed disparities. These findings support targeted efforts focused on multilevel disease, standardized post-procedure surveillance pathways, and expedited access to limb salvage to reduce amputation inequities.