PATIENTS with autoimmune rheumatic diseases face significantly greater risks of complications after undergoing endovascular interventions for lower extremity arterial disease, according to a large U.S. inpatient analysis.
Researchers evaluated outcomes using the 2012–2020 Nationwide Inpatient Sample, focusing on adults diagnosed with lower extremity arterial disease who received percutaneous endovascular interventions. Patients were stratified into systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, or no autoimmune disease. The primary outcomes assessed included in hospital mortality, discharge to a long term care facility, prolonged length of stay, and complications such as infection and amputation.
Among 71,436 weighted patients, 1,739 (2.4%) had an autoimmune rheumatic disease. Rheumatoid arthritis was the most prevalent, accounting for 1.8% of the cohort. Compared with the reference group, patients with rheumatoid arthritis experienced significantly higher risks of discharge to long term care (adjusted odds ratio 1.41), prolonged hospitalisation (aOR 1.39), and any in hospital complication (aOR 1.33). These complications included sepsis, infection, and below knee amputation.
Patients with systemic sclerosis demonstrated particularly elevated risks of respiratory complications and limb loss. They had more than double the odds of pneumonia (aOR 2.02), increased rates of respiratory failure (aOR 1.77), and almost triple the risk of minor amputations (aOR 2.89). By contrast, patients with systemic lupus erythematosus had outcomes similar to those of the general population.
Despite these increased risks, in hospital mortality and overall hospital costs did not differ significantly among groups. The study underscores that while survival outcomes remain stable, morbidity and quality of recovery are affected by the presence of autoimmune disease, particularly rheumatoid arthritis and systemic sclerosis.
The authors conclude that tailored peri operative planning is essential for these patients, recommending proactive strategies and multidisciplinary collaboration to mitigate complications. Identifying those at highest risk before intervention could improve recovery and reduce the burden of extended hospitalisation and infectious outcomes.
Reference: Huang YF, Lu MY. Outcomes of Lower Extremity Artery Endovascular Interventions in Patients with Autoimmune Rheumatic Disease: An Analysis of the US Nationwide Inpatient Sample 2012 – 2020. Eur J Vasc Endovasc Surg. 2025:S1078-5884(25)00939-6.
