Nationwide Outcomes of Acute Limb Ischemia: A Real-World Analysis Using the Truveta Electronic Health Record Network

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

J Vasc Surg

Keywords

acute kidney failure, acute limb ischemia, aged, amputation, amputation free survival, anemia, chronic kidney failure, cohort analysis, comorbidity, conference abstract, controlled study, diabetes mellitus, diagnosis, electronic health record, female, hospitalization, human, length of stay, major clinical study, male, mortality, overall survival, pneumonia, retrospective study, revascularization, surgery, very elderly

Abstract

Objectives: Acute limb ischemia (ALI) remains a morbid vascular emergency, yet nationwide outcomes are poorly characterized. Leveraging the Truveta electronic health record (EHR) network, we sought to evaluate outcomes of ALI across the US. Methods: Patients with a diagnosis of ALI were identified in the Truveta EHR network from 2015 to 2024. Demographics, comorbidities, and procedural details were extracted. Initial treatment strategy was categorized as open revascularization, endovascular intervention, or primary amputation. ALI diagnosis and procedures were identified using International Classification of Diseases, 10th edition, and Current Procedural Terminology codes. The primary outcome was overall survival. Secondary outcomes included freedom from reintervention and amputation-free survival. Descriptive statistics, univariate, and multivariate analyses were used to evaluate outcome differences across treatment groups. Results: Among 42,502 patients diagnosed with ALI, 16,615 (39.1%) underwent intervention during the index hospitalization. Initial treatment consisted of endovascular revascularization in 9045 patients (54.4%), open revascularization in 7177 (43.2%), and primary amputation in 393 (2.4%). Median age was 67 years, and 56.8% were male. Patients treated with primary amputation had higher rates of diabetes (33.6%) compared with endovascular revascularization (28.7%) or open repair (22.1%) (P < .001). Similar patterns were observed for anemia (26.7% vs 17.9% vs 15.6%; P < .001) and chronic kidney disease (19.8% vs 14.8% vs 12.8%; P < .001). Procedural timing and hospital length of stay (LOS) differed, with longer time to intervention among amputation patients (4 days vs 1 days vs 0 days; P < .001) and longer median LOS (15 days vs 6 days vs 7 days; P < .001). Thirty-day mortality was highest following amputation (13.5%) compared with endovascular (7.4%) and open repair (8.5%) (P < .001). Rates of acute kidney injury (29.5% vs 22.0% vs 23.4%; P < .001) and pneumonia (18.3% vs 11.9% vs 12.2%; P < .001) were also increased after amputation. Five-year overall survival was 60%, with lower survival among amputation patients compared with revascularization strategies (P < .001). Freedom from reintervention was greater after open repair (77%) compared to endovascular therapy (60%) (P < .001). Conclusions: In a large nationwide EHR-based cohort of patients hospitalized with ALI, most patients that underwent intervention had endovascular revascularization. While long-term limb preservation was high across revascularization strategies, open repair was associated with greater durability as reflected by lower reintervention rates. Differences in procedural timing, LOS, and outcomes across treatment approaches highlight substantial heterogeneity in ALI management. These findings underscore the need to better define optimal treatment selection and care pathways for patients presenting with ALI. [Formula presented]

Volume

84

Issue

1

First Page

e126

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