title: Poorer limb salvage in African American men with chronic limb ischemia is due to advanced clinical stage and higher anatomic complexity at presentation.
abstract: OBJECTIVE
  African Americans (AAs) with symptomatic peripheral arterial disease (PAD) have been reported to have fewer revascularization attempts and poorer patency and limb salvage (LS) rates than Caucasians (CAUs). This study compared the outcomes between AA and CAU men with chronic limb ischemia.
  
  
  METHODS
  All AA and CAU men who underwent treatment for symptomatic PAD between November 1, 2003, and May 31, 2012, were included. Patency rates, LS, major adverse cardiovascular and limb events, amputation-free survival, and survival were compared before and after propensity score matching and with multivariate (Cox regression) analysis.
  
  
  RESULTS
  Of the 834 men (1062 limbs), 107 were AA (137 limbs) and 727 were CAU (925 limbs). AAs were more likely to have insulin-dependent diabetes mellitus, hypertension, dialysis dependence, lower albumin levels, and critical limb ischemia (73% vs 61%; P = .006), whereas CAUs had more coronary artery disease, dyslipidemia, and chronic obstructive pulmonary disease. In patients with critical limb ischemia, primary amputation rates (10.9% vs 7.2%; P = .209) were similar between groups; however, infrapopliteal interventions were more frequent in AAs (62.6% vs 44.3%; P = .004). Perioperative morbidity and mortality rates were similar. Mean follow-up was 38.5 ± 28.9 months (range, 0-119 months). Patency rates, major adverse limb and cardiovascular events, amputation-free survival, and survival were similar in AAs and CAUs; however, the LS rate was significantly lower in AA (73% ± 6% vs 83% ± 2%; P = .048), mainly due to the difference in the endovascular-treated group (5-year LS, 69% ± 7% in AAs vs 84% ± 2% in CAUs; P = .025). All outcomes were similar in propensity score-matched cohorts. In multivariate analysis, insulin-dependent diabetes mellitus, gangrene, poor functional capacity, dialysis-dependence, and need for infrapopliteal revascularization were independently associated with limb loss, whereas race was not.
  
  
  CONCLUSIONS
  AA men with symptomatic PAD were found to have lower LS rates than CAUs. However, this was likely due to presenting with advanced ischemia or with poor prognostic factors that are independently associated with limb loss.
authors.affiliation: Division of Vascular Surgery, Veterans Affairs Western New York Healthcare System, Buffalo, NY; Division of Vascular Surgery, Department of Surgery, State University of New York at Buffalo, Buffalo, NY.
authors.forename: Mariel
authors.initials: M
authors.lastname: Rivero
authors.affiliation: Department of Anesthesiology, Veterans Affairs Western New York Healthcare System, State University of New York at Buffalo, Buffalo, NY.
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
authors.affiliation: Division of Vascular Surgery, Department of Surgery, State University of New York at Buffalo, Buffalo, NY.
authors.forename: Raphael
authors.initials: R
authors.lastname: Blochle
authors.affiliation: Division of Vascular Surgery, Department of Surgery, State University of New York at Buffalo, Buffalo, NY.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Harris
authors.affiliation: Division of Vascular Surgery, Department of Surgery, State University of New York at Buffalo, Buffalo, NY.
authors.forename: Maciej L
authors.initials: ML
authors.lastname: Dryjski
authors.affiliation: Division of Vascular Surgery, Veterans Affairs Western New York Healthcare System, Buffalo, NY; Division of Vascular Surgery, Department of Surgery, State University of New York at Buffalo, Buffalo, NY. Electronic address: dosluoglu@yahoo.com.
authors.forename: Hasan H
authors.initials: HH
authors.lastname: Dosluoglu
mesh_terms: D001741:Black or African American; D000368:Aged; D000671:Amputation, Surgical; D002908:Chronic Disease; D015897:Comorbidity; D016208:Databases, Factual; D018572:Disease-Free Survival; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D044465:White People