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

<b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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 (<i>p</i> = 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, <i>p</i> = 0.01), but not with limb salvage or patency loss. <b>Conclusion:</b> 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.