Patients with premature peripheral arterial disease (PAD) face a significantly increased risk of mid- and late-term major amputation, according to a new analysis of the linked Vascular Quality Initiative and Medicare dataset (VQI-VISION). The research was presented at the 2026 annual meeting of the Southern Association for Vascular Surgery (SAVS) in Paradise Island, the Bahamas (Jan. 21–24).
Premature PAD is defined by onset before 50 years of age and only represents about 1.6% of cases. Olamide Alabi, MD, lead author on the study and associate professor of surgery at Emory University School of Medicine in Atlanta, Georgia, said that some anecdotal data suggests these patients have worse outcomes after revascularization. “We wanted to look within the VQI, which is the largest vascular surgery registry, to determine if that was in fact the case,” she said.
The study looked at over 15,000 patients who underwent endovascular peripheral vascular intervention (PVI) for arterial occlusive disease between January 2017 and December 2018. Demographics, outcomes, and characteristics were analyzed between premature PAD and traditional-age patients. Primary outcomes were the risk of major amputation and mortality at 30 days, 90 days, and one year.
Results found premature PAD patients have a higher disease burden, including increased prevalence of obesity, diabetes and advanced kidney disease. They were also more likely to have a prior history of amputation and were less likely to receive guideline-directed medical therapy. “Statins save limbs and lives,” said Alabi. “If you are a patient with PAD and you are not on them, your life will be shorter and you certainly have a higher risk of losing your leg.”
Among the 351 patients with premature PAD, major amputation rates were higher at each time point. They also experienced a shorter mean time-to-amputation when compared to older PAD patients. Despite a mean age difference of 28.3 years, the data found there was no significant difference in all-cause mortality and a similar mean time-to-death between the two groups. “These younger patients are equally likely to die and die within the same timeframe after their revascularization as the older group of patients,” said Alabi. “That’s concerning.”
Alabi said the increased amputation rates point to issues in early detection. “It’s clear that patients with premature PAD are not being found early enough,” she said. The research also found that these patients were more likely to present with chronic limb-threatening ischemia (CLTI). “We’re not missing the majority of patients,” said Alabi. “But we’re certainly missing a large group of patients who could potentially have their limbs saved and could potentially have longer lifespans.”
Another finding from the study showed that minority groups were more prevalent in the premature PAD group. “We already know that Black patients with PAD have higher rates of amputation,” said Alabi. “The same is true within the premature PAD group.” There was also a higher proportion of women. “Women are always the ones described as having atypical symptoms,” said Alabi. “If we’re waiting until they have symptoms, which tends to be the end stage manifestation of PAD, we’ve already missed the boat.”
The findings add to the growing amount of data that show a need for better screening, said Alabi. “I don’t think screening should be limited to age 65,” she said. “If you have certain risk factors, particularly diabetes and chronic kidney disease, you should be screened for PAD.” Alabi added that several national screening initiatives are underway, but many still restrict eligibility based on age.
In addition to screening, Alabi said improvements in guideline-directed medical therapy for these patients need to become a priority. However, she said diagnosis remains the biggest challenge. “We have to know they have PAD for them to be prescribed these medications,” said Alabi. She emphasized the importance of patient education, noting that many patients with PAD don’t even know the name of their disease, which she said is likely due to a lack of appropriate counseling.
“We need to liberally provide screening for these patients because we could literally save their lives and limbs,” said Alabi. “It’s really bad for you if you lose your leg. But it’s actually bad for our communities and it’s bad for the health care system. If you lose your leg, that is somebody out of the workforce, that is someone who can no longer be the breadwinner for their family. There are very real costs to these individuals, to their families, but also to the greater society.”
