Black women with claudication had the highest rate of progression to chronic limb-threatening ischemia (CLTI) after lower extremity revascularization at 180 days, new data from a Medicare-linked Vascular Quality Initiative (VQI) procedural registry show.
The results were demonstrated in a national cohort study of VQI-Vascular Implant Surveillance and Interventional Outcomes Network (VQI-VISION) study exploring the impact of intersectional identity among patients with claudication on progression to CLTI, amputation and mortality following revascularization. The data were recently published in JAMA Surgery and first appeared as a plenary presentation at the 2025 Association of VA Surgeons annual meeting (April 6–8) in Atlanta, Georgia.
The study—led by Olamide Alabi, MD, an associate professor in the Department of Surgery at Emory University School of Medicine in Atlanta—lays out how among 10,012 adults with claudication, the rate of symptom progression from claudication to CLTI was 5.85% at 180 days. Median progression was 5.4% among men and 6.5% among women, Alabi and colleagues report. Ethnoracial differences in median percentage disease progression among men were detected—7.2% in Black, 8.8% in Hispanic and 5.2% in White men progressing to CLTI within 180 days after their index revascularization. Median progression at one year was lowest among White men (9.2%) and White women (10.1%), and highest among Black men (13.7%) and Black women (18.7%).
On univariate Cox regression analysis, the risk of progression to CLTI within 180 days after index revascularization for claudication did not significantly differ when comparing Black to White men or when comparing Hispanic to White men, Alabi et al find. There were no significant differences between Hispanic and White women, but Black women were “twice as likely to progress to CLTI within 180 days after index [lower extremity revascularization] for claudication [than White women],” they report, with a hazard ratio (HR) of 2.06 (95% confidence interval [CI], 1.49–2.84; p<0.001).
“Our study took the examination of progression to CLTI among patients with claudication a step further to better understand intersectional ethnoracial and gender identity and its association with progression to CLTI,” the authors write in JAMA Surgery. “We found that Black women with claudication had the highest risk for CLTI progression at both 180 days and at one year. Vascular clinicians’ awareness of intersectional disparities in claudication outcomes will augment their ability to appropriately counsel patients regarding their individualized risks for adverse outcomes.”
Concluding, Alabi and colleagues point to a “lack of adherence” to established appropriate use criteria (AUC), overutilization and/or early revascularization among those with claudication as potentially perpetuating “disparate care”. “Given the preponderance of evidence and societal guidelines describing the value of exercise therapy as first-line treatment for claudication and established poor equitable application of [guideline-directed medical therapy], there is a critical need to develop evaluative metrics at the payor and policy level that ensure that all patients with claudication receive the equitable care they deserve,” they note.
