Concurrent Peripheral Arterial Disease Predicts Re-Intervention Following Abdominal Aortic Aneurysm Repair: A Single-Centre Propensity Matched Retrospective Study

Abstract

Purpose: Abdominal aortic aneurysm (AAA) and peripheral arterial disease (PAD) share common risk factors and may co-exist in patients undergoing AAA repair. The impact of concomitant PAD on clinical outcomes post AAA repair remains unclear. This study aims to evaluate whether concurrent PAD is associated with adverse clinical outcomes following AAA repair. Materials and Methods: This was a single-centre retrospective propensity matched analysis involving patients undergoing infrarenal AAA repair at a single UK centre (2009-2022). Peripheral arterial disease was defined as symptomatic lower limb disease requiring surgical or radiological intervention, independent of the AAA procedure. Propensity score matching (2:1 nearest neighbour, calliper 0.2) was performed to balance PAD and non-PAD cases. Outcomes included all-cause mortality, re-intervention, and procedure-specific complications. Results: Of 1703 patients who underwent infrarenal AAA repair, 90 had undergone intervention for PAD. Peripheral arterial disease was significantly associated with reintervention, graft infection, and iliac intervention for open and endovascular repair patients. On propensity matching, PAD was significantly associated with re-intervention in patients who had open repair (odds ratio [OR], 3.87; 95% CI, 1.39-10.89; P = .01) and iliac intervention in patients who underwent endovascular aortic repair (OR, 9.27; 95% CI, 1.96-43.86; P = .006). No significant association between concurrent PAD and endoleak was identified, nor any significant association with mortality. Conclusion: Intervention-requiring PAD was associated with re-intervention following AAA repair but not with mortality, though this may reflect insufficient power, highlighting the importance of stratified follow-up and perioperative planning in this group. Clinical Impact Co-existent peripheral arterial disease (PAD) identifies patients at increased risk of procedural complications requiring further intervention following abdominal aortic aneurysm repair. Recognition of PAD should therefore inform preoperative planning, particularly assessment of iliac anatomy and access in patients undergoing EVAR. Clinicians should consider closer postoperative surveillance in this higher-risk group to facilitate earlier detection and treatment of complications. These findings support incorporating PAD into perioperative risk assessment and follow-up strategies. The study also highlights the importance of individualised vascular management and optimisation of cardiovascular risk factors.