Skip to main content
2025 Vascular Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Ticketed Event
Ticketed Event

Poster Competition

(PC150) Impact of Emergency Department Presentation for Chronic Limb-Threatening Ischemia on Limb Loss Rates in a Public Safety-Net Population

Friday, June 6, 2025
12:30 PM - 2:00 PM CT

    Submitting & Presenting Author(s)

  • Ahmed Naiem, MD

    University of California San Francisco
    San Francisco, California

    • Co-Author(s)

  • AO

    Adam Oskowitz

  • Michael S. Conte, MD

    Professor and Chief
    Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA, USA
    San Francisco, California

    • Senior Author(s)

  • Shant M. Vartanian, MD

    University of California San Francisco
    San Francisco, California

Objectives: Safety-net populations present with more advanced CLTI and disproportionally utilize emergency services for access to care. This study assesses the impact of emergency department (ED) presentation on limb loss rates in patients with chronic limb-threatening ischemia (CLTI) at a safety-net hospital.

Methods: This is a retrospective analysis of consecutive patients undergoing infra-inguinal revascularization for CLTI between January 2020 and January 2024 at a safety-net public hospital. Patients undergoing revascularization following ED presentation (ED) were compared with planned, elective revascularization (PR). Baseline characteristics, CLTI severity (WIfI), and anatomical severity (GLASS) were recorded. The primary outcome was major amputation. Secondary outcomes were death, reintervention, minor, and major adverse limb events (MALE). Chi-square and t-tests were used for comparative analysis. Kaplan-Meier survival estimates were used for the primary outcome. A Cox proportional hazards model identified predictors of major amputations.

Results: The study included 146 limbs in 128 patients (49% ED/ 51% PR). Majority of patients were males (64% ED/ 72% PR, p=.317) and non-white (83% ED/ 92% PR, p=.355). Diabetes mellitus (72% ED/ 74% PR, p=.774) and dialysis-dependence (22% ED/ 22% PR, p=.930) were similar. ED patients had lower antiplatelet use (61% ED vs 78% PR; p=.023). Differences in WIfI stage 4 (72% ED/ 32% PR, p<.001) were driven by infection (grade 3 infection: 31% ED/ 3% PR, p<.001). Severe infrapopliteal disease was similar (GLASS IP 4: 38% ED/ 21% PR, p=.129). Baseline characteristics are detailed in table I. Major amputations were higher among ED (28% vs PR 11%, p=.009; Figure 1). There were no significant differences in death (31% ED/ 24% PR, p=.417), reinterventions (26% ED/ 41% PR, p=.070), minor amputations (60% ED/ 49% PR, p=.179) and MALE (31% ED/ 19% PR, p=.103) between cohorts. A Cox proportional hazards model identified ED revascularization (HR 3.10, 95% 1.16 – 8.29, p=0.024) and insulin-dependent diabetes (HR 2.95, 95% CI 1.06 – 8.20, p=.038) as independent predictors of major amputation.

Conclusions: In this study, half of CLTI revascularization were performed following emergent presentation through the ED. Patients were twice as likely to have advanced CLTI (WIfI stage 4), driven mainly by severe infection. Major amputation rates were more than doubled in patients managed through the emergency department. ED revascularization independently predicted a three-fold increase in major amputations. Population health strategies targeting earlier diagnosis and engagement with vascular specialists are needed to reduce major amputation rates in a safety net population.