Abstract Body (Do not enter title and authors here): Introduction
Peripheral arterial disease (PAD) complicated by acute limb ischemia (ALI) is a vascular emergency. The emergence of COVID-19, with its known prothrombotic effects, has raised the likelihood of worse vascular outcomes in this vulnerable cohort. This study aims to evaluate how concurrent infection with COVID-19 impacts in-hospital mortality among patients hospitalized with both PAD and ALI using a nationally representative database.

Methods
We used the HCUP-NIS dataset (2020–2022) to identify adult hospitalizations with both peripheral arterial disease and acute limb ischemia using ICD-10 codes. COVID-19 status and in-hospital mortality were recorded. Survey-weighted logistic regression was used to adjust for age, sex, race, income, and Charlson Comorbidity Index (CCI).

Results
14,959 patients were admitted with ALI and PAD. Out of this 789 had COVID-19 (5.27%) and the remaining 14,170 (94.73%) were negative.
In-hospital mortality was 27.76% in patients with COVID-19 compared to 6.37% in COVID negative patients (p < 0.001).
After adjusting for age, race, sex, income, and comorbidity burden using the CCI, COVID-19 remained a strong independent predictor of in-hospital death (p < 0.001). Increasing age and higher CCI scores were also independently associated with mortality.
We evaluated calendar-year trends in in-hospital mortality among patients with PAD, ALI, and concurrent COVID-19 infection from 2020 to 2022. After adjusting for co-variates, there was no statistically significant difference in mortality across the three years. Compared to 2020, the adjusted odds of in-hospital death were not significantly different in 2021 (p = 0.959) or in 2022 (p = 0.256).