Peripheral Artery Disease Presentation and Outcomes in the Systemic Lupus Erythematosis Population

The increased risk of cardiovascular disease and accelerated atherosclerosis in patients with systemic lupus erythematosus (SLE) is well-documented; however, reports suggest presentation with tissue loss is quite low (1.4%). There is little known about peripheral artery disease presentation severity and outcomes in patients with SLE. We examined patients with SLE who underwent lower extremity revascularization (LER) between 2010 and 2022 in our academic health system. Demographics, indication for procedure, revascularization method(s), and outcomes (reintervention, major amputation, and mortality) were reviewed. Among 103 patients with SLE undergoing LER, the median age was 63.7 years (interquartile range [IQR], 54-73 years), 84 (81.6%) were female, and 54 (52.4%) were Black/African American. Of note, 55.3% (n = 57) were under age 65. Symptoms on presentation included acute limb ischemia (n = 9; 8.7%), claudication (n = 22; 21.3%), and chronic limb-threatening ischemia (CLTI) (n = 71; 68.9%). Among those who presented with acute limb ischemia, 22.2% (n = 2) had subsequent major amputation within 30 days. Among the 71 CLTI patients, 52.4% had tissue loss. The index procedure for the vast majority of these patients was a diagnostic angiogram (n = 37; 52.1%), and only three of these proceeded with therapeutic angiogram. There were 28 patients who had endovascular revascularization as their index procedure and five patients who had surgical bypass, and one had a hybrid intervention. The anatomic distribution of intervention is as follows: aortoiliac 11.2% (n = 8), femoropopliteal 14.1% (n = 10), femoropopliteal + tibial 9.9% (n = 7), and tibial only 12.7% (n = 9) In our cohort of SLE patients with CLTI, reintervention rates at 30 days and 90 days were 14.1% and 21.1%, respectively. Major amputation rates at 30 days, 90 days, and 1 year were 11.3%, 14.1%, and 19.7%, respectively. Mortality rates at 30 days, 90 days, and 1 year were 1.4%, 5.6%, and 12.7% respectively. SLE patients with PAD are young, predominantly female and Black, and present quite often with CLTI, despite previous reports. As well, compared to published data on CLTI cohorts, their outcomes are exceedingly poor. Given contemporary trial data, it is important to define optimal screening and examine the benefit or harm of variable practice patterns and revascularization methods in this population.