Vascular surgeons have better limb salvage outcomes than non-vascular surgeons in chronic limb-threatening ischemia

Background While the treatment of peripheral artery disease with lower extremity bypass is performed primarily by board-certified vascular surgeons, a subset of non-vascular surgeons continues performing these cases. We investigated differences in practice patterns and surgical outcomes between vascular and non-vascular surgeons for bypass in patients with claudication and chronic limb-threatening ischemia (CLTI). Methods The ACS-NSQIP targeted database from 2011 to 2022 was used to select non-emergent claudication and CLTI patients. Propensity matching (3:1) was applied to balance demographics and comorbidities between vascular and non-vascular surgeons. Claudication and CLTI cohorts were analyzed separately. Thirty-day outcomes were examined. Results Femoropopliteal bypass was the most common procedure followed by femoral-distal bypass for both vascular and non-vascular surgeons. Vascular surgeons were more likely to perform femoral-distal procedures and use single-segment saphenous vein grafts (SSSV) for both claudication and CLTI. Vascular surgeons were less likely to use other non-SSSV conduits for claudication patients (40.6% vs 54.6%, p < 0.01), but no difference in CLTI (38.9%% vs 40.1%, p = 0.74). There was no significant difference in 30-day mortality/morbidities between surgeons for either claudication or CLTI. However, 30-day major amputation for CLTI was significantly better with vascular surgeons (3.0% vs 7.5%, p < 0.01). In CLTI patients, after correcting for operation type and conduit usage, vascular surgeons continued to be associated with lower major amputation (aOR = 0.46, 95 CI = 0.29–0.72, p < 0.01). Conclusion Vascular surgeons have better limb salvage than non-vascular surgeons. This could not be explained by the higher use of SSSV; thus, other factors such as surgical skill may account for better outcomes.