Journal
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Volume 66, Issue 2, Pages 237-244Publisher
W B SAUNDERS CO LTD
DOI: 10.1016/j.ejvs.2023.05.027
Keywords
Aboriginal and Torres Strait Islander Australians; Chronic limb threatening ischaemia; Diabetes related foot disease; Peripheral artery disease
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This study investigated the distribution, severity, and outcome of peripheral artery disease (PAD) in Aboriginal and Torres Strait Islanders compared with non-indigenous Australians. The results showed that Aboriginal and Torres Strait Islander patients had a higher likelihood of presenting with chronic limb threatening ischaemia symptoms, more severe angiographic scores, particularly in the tibial arteries, and a higher risk of major amputation and major adverse cardiovascular events compared with non-indigenous Australians.
Objective: This retrospective cohort study investigated the anatomical distribution, severity, and outcome of peripheral artery disease (PAD) in Aboriginal and Torres Strait Islanders compared with non-indigenous Australians.Methods: The distribution, severity, and outcome of PAD were assessed using a validated angiographic scoring system and review of medical records in a cohort of Aboriginal and Torres Strait Islander and non-indigenous Australians. The relationship between ethnicity and PAD severity, distribution, and outcome were examined using non-parametric statistical tests, Kaplan-Meier and Cox proportional hazard analyses.Results: Seventy-three Aboriginal and Torres Strait Islanders and 242 non-indigenous Australians were included and followed for a median of 6.7 [IQR 2.7, 9.3] years. Aboriginal and Torres Strait Islander patients were more likely to present with symptoms of chronic limb threatening ischaemia (81% vs. 25%; p < .001), had greater median [IQR] angiographic scores for the symptomatic limb (7 [5, 10] vs. 4 [2, 7]) and tibial arteries (5 [2, 6] vs. 2 [0, 4]) and had higher risk of major amputation (HR 6.1, 95% CI 3.6 -10.5; p < .001) and major adverse cardiovascular events (HR 1.5, 95% CI 1.0 -2.3; p = .036) but not for revascularisation (HR 0.8, 95% CI 0.5 -1.3; p = .37) compared with non-indigenous Australians. The associations with major amputation and major adverse cardiovascular events were no longer statistically significant when adjusted for limb angiographic score.Conclusion: Compared with non-indigenous patients, Aboriginal and Torres Strait Islander Australians had more severe tibial artery disease and a higher risk of major amputation and major adverse cardiovascular events.
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