Impact of Hospital Volume on Procedural Failure of Endovascular Treatment for Acute Limb Ischemia: The Japanese Nationwide Endovascular Therapy Registry

Abstract

Endovascular therapy (EVT) is increasingly used to treat acute limb ischemia (ALI), a condition with high risks of limb loss and mortality. While high hospital volumes are linked with better outcomes in chronic lower extremity arterial disease (LEAD), the impact of hospital volume on ALI outcomes remains unclear. This study evaluated the relationship between hospital volume and procedure failure in ALI. Data from 3437 ALI patients undergoing EVT at 464 hospitals, sourced from the Japanese Endovascular Therapy (J-EVT) registry (2017–2022), were analyzed. Hospital volume was defined as the number of EVTs performed for LEAD at each hospital in the prior year. Propensity score matching (1:1) adjusted the baseline characteristics between low-volume (<53 cases/year) and non-low-volume hospitals. The primary outcome was procedural failure, defined as residual stenosis >30%. Secondary outcomes were perioperative complications. Low-volume hospitals had a significantly higher rate of procedural failure (11.7% vs 8.0%, P = .008), but perioperative complication rates were similar (6.6% vs 5.4%, P = .35). Generalized propensity score analysis confirmed a strong inverse correlation between hospital volume and procedural failure. Higher hospital volumes were associated with better EVT procedural outcomes for ALI, highlighting the importance of centralized care in non-low-volume hospitals.