Perioperative and Long-Term Outcomes of Lower Extremity Revascularization in Patients With Malignancy

ObjectiveCancer patients in general are thought to be poor candidates for lower extremity revascularization procedures due to hypercoagulability, potential need for chemotherapy, or multiple other cancer-related co-morbidities. While vascular surgeons may shy away from these patients, only one previous study we found has assessed the effect of this relationship on lower extremity bypass patency, and substantially worse outcomes were documented. Our study aims to quantify the risk of poor outcomes for lower extremity revascularization in a large sample of cancer patients, utilizing the TriNetX database.MethodsWithin the US cohort of 55 healthcare organizations in the TriNetX database, we identified 1419 patients diagnosed with either breast, prostate, colon, or non-small cell lung cancer of any stage and 60 609 patients without diagnosis of those cancers who had undergone either an open infra-inguinal bypass of any graft type or endovascular intervention on the infra-inguinal arteries from September 3, 2004 to September 3, 2024. Propensity score matching was conducted, which yielded 1413 patients analyzed in each group, and incidence of arterial thrombectomy, bypass revision, amputation, and arteriogram were recorded for each group at 30-day and 1-year time points. Secondary subgroup analyses were conducted within the cancer cohort to determine whether rates of the same outcomes listed above varied between open versus endovascular interventions.ResultsIn the primary analysis, there was no significant difference in any of the 4 outcomes between cancer patients and non-cancer patients. In the subgroup analysis, open bypass was found to have a significantly lower incidence of repeat arteriogram within 30 days as compared to endovascular intervention (3.62% vs 7.97%; risk ratio RR, 0.455, P = 0.029) and 1 year (18.84% vs 28.62%; risk ratio RR, 0.658, P = 0.007). All other outcomes in both the 30-day and 1-year follow-up periods for the subgroup analysis did not vary significantly between the 2 groups.ConclusionIt is possible that patients with a recent diagnosis of cancer may not have worse outcomes for lower extremity bypass compared to patients without a cancer diagnosis. Cancer patients undergoing endovascular interventions, in contrast, did require more repeat interventions which may suggest that open interventions are preferable in this population. We would, however, caution that overall limb salvage was reasonable in this patient population and results were not markedly worse with any intervention strategy. Cancer diagnosis should not necessarily be seen as a contraindication to a lower extremity revascularization and should be considered on a case-by-case basis.