Hypercoagulability predicts worse outcomes in young patients undergoing lower extremity revascularization.

Objective: Although we know that young patients with peripheral artery disease (PAD) have worse outcomes than older patients, there is a scarcity of information about the incidence of hypercoagulability in this population. Our aim was to analyze outcomes of young patients diagnosed with a hypercoagulable state (unusual tendency toward thrombosis) after lower extremity revascularization compared with similar patients without hypercoagulability.
Methods: All patients 50 years of age or younger undergoing an initial procedure for lower extremity PAD from 2000 to 2015 at the Cleveland Clinic were retrospectively analyzed. Patients with a hypercoagulability panel were included and classified into groups as hypercoagulable positive (HP) or hypercoagulable negative (HN). Demographics, preoperative risk factors, form of presentation, level of disease, and type of intervention were analyzed in addition to perioperative complications, early failure, and length of stay. Primary outcomes were limb loss and primary, primary assisted, and secondary patencies. Outcomes were analyzed and Kaplan-Meier curves generated.
Results: Ninety-one patients were included for a total of 118 limbs. Mean follow-up was 32 months; 55% of patients had a hypercoagulable disorder, with 59% having lupus anticoagulant and 32% hyperhomocysteinemia. In the HP group, 71% were men; 49% were men in the HN group. Patients overall had a high prevalence of smoking (86%), hypertension (36%), and hyperlipidemia (33%). Acute limb ischemia was the most common form of presentation for both groups (50% HP, 38% HN). The aortoiliac segment was the most commonly affected (38% HP, 50% HN). The most frequent operation in the HN group was endarterectomy or bypass (32%); in the HP group, it was an endovascular intervention (29%). Perioperative occlusion or failure was 18% in the HN group vs 30% in the HP group (P > .05). Primary patency, primary assisted patency, and secondary patency at 36 months were all better for the HN group (no statistical significance) in all treatment groups. Major amputation at 36 months was significantly worse for the HP group (40% vs 10% in the HN group; P < .005). There was no difference in perioperative complications or length of stay.
Conclusions: Young patients undergoing lower extremity revascularization for PAD have worse outcomes when associated with hypercoagulability. There are trends to decreased patency of revascularization in these patients, with significantly more major amputations. No clear differences between modalities of treatment were demonstrated.
(Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)