OR9-2 | Impact of Endovascular Revascularization on Amputation Rates in Chronic Total Occlusion-Peripheral Artery Disease: Insights from a National Registry

Endovascular revascularization (EVR) is a treatment option for chronic total occlusion in peripheral artery disease (CTO-PAD). However, there is a lack of data regarding the rates of amputation and outcomes following this procedure The National Readmission Database was queried between 2016 and 2020 to identify patients ≥18 with CTO-PAD who underwent endovascular revascularization. Surgically re-vascularized patients were excluded. Outcomes were defined as post-index procedure major amputations. We identified 92,433 patients with CTO-PAD; 64.6% underwent EVR (n=59,748, mean age: 69.7 years) while 35.4% were not revascularized (No-EVR, n=32,685, mean age: 70.4 years). Baseline characteristics are detailed in Figure 1a. EVR patients had a lower Elixhauser comorbidity index than their counterparts (4.85 [95% CI: 4.83-4.88] vs 5.38 [95% CI: 5.34-5.41], p=<0.0001). During the initial admission, mortality was lower in patients who underwent EVR (2.6% vs 5.6%, p=<0.001). Major amputation rates were significantly lower in patients who underwent EVR as compared to No-EVR (6.2% vs 14.1%, p=<0.001). Moreover, EVR patients had a lower major amputation risk in readmissions within a year (HR 0.72 [95% CI: 0.66-0.78], p=<0.001) as compared to No-EVR patients (HR 1.38 [95% CI: 1.26-1.50], p<0.001), Figure 1b. Our findings suggest that EVR significantly lowers major amputation risks in CTO-PAD patients, both initially and in later admissions, as compared to those who do not undergo EVR. Further research is needed to assess the short and long-term outcomes to guide clinical care in these patients.