Active malignancy does not affect limb salvage and reocclusion in patients with acute limb ischemia: A single-center experience

Background: This study aimed to assess the impact of active malignancy on outcomes in patients undergoing revascularization for acute limb ischemia (ALI), focusing on mortality, limb salvage, and patency loss. Methods: We conducted a retrospective analysis of consecutive patients with ALI who underwent lower-limb revascularization over a 7-year period. Patients were stratified into two groups based on the presence of active malignancy at ALI diagnosis. Kaplan–Meier analysis was used to assess survival, limb salvage, and freedom from reocclusion. Cox proportional hazards models were applied to identify independent predictors of mortality, major amputation, and reocclusion. Results: A total of 296 patients were included, with a mean age of 76.2 ± 12.6 years; 62.8% were men. Most occlusions involved the femoropopliteal segment (57.8%). Thirty-eight patients (12.8%) had active malignancy. Baseline characteristics, interventions, and 30-day outcomes were similar between groups. Over a median follow up of 29.8 ± 24.6 months, 140 deaths (47.3%) were recorded. Patients with malignancy had significantly worse survival (p = 0.005), but similar rates of limb salvage and freedom from reocclusion. In multivariable analysis, active malignancy was independently associated with higher mortality (OR 3.321, 95% CI 1.310–8.418, p = 0.01), but not with limb salvage or patency loss. Conclusion: Active malignancy is associated with increased mid- and long-term mortality in patients with ALI, yet limb-related outcomes remain comparable to nononcological patients. Aggressive revascularization strategies should not be withheld solely due to malignancy when clinically appropriate.