Superficial Femoral Artery Disease as a Cardiovascular Prognostic Predictor in Aortoiliac Revascularization - A Cohort Study

Abstract

Introduction: Aortoiliac disease is a severe manifestation of peripheral arterial disease (PAD) that reduces blood flow to the lower limbs, leading to significant morbidity and mortality. The prevalence of PAD is increasing, particularly in low and middle-income countries. This study aims to evaluate the prognostic value for Major Adverse Cardiovascular Events (MACE) of superficial femoral artery (SFA) disease in patients undergoing aortoiliac revascularization. Methods: This prospective cohort study included all consecutive patients who underwent elective aortoiliac revascularization between January 2013 and September 2022 at both a central and a district hospital, representing two healthcare facilities within the Portuguese Health System. Only patients with aortoiliac Transatlantic Inter-Society Consensus (TASC) II type D lesions were included, excluding those with aortoiliac aneurysmal disease. Moreover, patients with severe multivessel disease in other arterial areas, apart from the aortoiliac artery and SFA were excluded. Patient demographics, clinical characteristics, and procedural details were collected. Outcomes were assessed in the first 30 days post-procedure and during long-term follow- up. Statistical analyses included Kaplan-Meier survival curves and multivariate Cox regression. Results: A total of 133 patients were included, with a mean age of 62.3 ± 9.23 years; 94.0% were male, and a median follow-up of 61[IQR - 55.0-67.0] months. SFA disease was present in 60.9% of patients and was associated with hypertension (p=0.025), coronary artery disease (p=0.005), congestive heart failure (p=0.020), and age (p=0.008). Patients with SFA disease had a lower 30-day ankle-brachial index (ABI) (p<0.001), smaller post-surgery ABI variation (p=0.003), longer hospital stays (p=0.005), and higher rates of major adverse limb event (MALE) (p=0.007). Survival analysis demonstrated increased long-term MALE, MACE, and all-cause mortality in patients with SFA disease. Multivariable analysis confirmed SFA disease as a significant predictor of all-cause mortality (HR=2.046 [1.042-4.443] p=0.048) and suggested a trend towards increased risk of MACE (HR=1.542, [0.866-3.101], p=0.075). Conclusion: This study identifies SFA disease as a critical prognostic marker for adverse cardiovascular outcomes in patients undergoing aortoiliac revascularization. Further research with larger sample sizes and longer follow-up periods is warranted to validate these findings and improve patient management strategies.