Functional status as a prognostic factor for primary revascularization for critical limb ischemia.
J Vasc Surg
; 51(2): 360-71.e1, 2010 Feb.
Article
in En
| MEDLINE
| ID: mdl-20141960
ABSTRACT
BACKGROUND:
Lower extremity arterial revascularization (LEAR) is the gold-standard for critical lower limb ischemia (CLI). The goal of this study was twofold. First, we evaluated the long-term functional status of patients undergoing primary LEAR for CLI. Second, prognostic factors of long-term functional status and survival after primary LEAR for CLI were assessed.METHODS:
All primary LEAR procedures were analyzed. Patients were stratified by preoperative functional status ambulatory (group I) vs nonambulatory (group II). Patients were followed-up after 3 and 6 years. Adverse events (AEs) were categorized according to predefined standards minor, surgical, failed revascularization, and systemic. Associated patient demographic/clinical data were analyzed using univariate and multivariate methods.RESULTS:
There were 106 LEAR patients (group I n = 42, 40% vs group II n = 64, 60%). Group II patients were significantly older (75 vs 62 years; P = .00), were classified ASA 3-4 more frequently (78% vs 52%; P < .02), had more cardiac disease (n = 42, 66% vs n = 10, 24%; P = .00), renal disease (n = 26, 41% vs n = 7, 17%; P = .00), diabetes (n = 36, 56% vs n = 8, 19%; P = .00), hypertension (n = 47, 73% vs n = 13, 31%; P = .00) and severe CLI (n = 42, 66% vs n = 18, 38%; P < .01). Group II patients had a higher incidence of death (65.6% vs 14.3%; P = .00), minor AEs (n = 38, 26% vs n = 10, 22%; P = .00), surgical AEs (n = 48, 33% vs n = 12, 26%; P < .02) and systemic AEs (n = 24, 86% vs n = 4, 9%; P < .02). Also more unplanned reinterventions occurred in group II (n = 148, 76% vs n = 47, 24%; P = .00). Nonambulatory status was a multivariate independent predictor of nonambulatory status after LEAR during 6 years follow-up (odds ration [OR[ 21.47; 95% confidence interval [CI] 2.76-166.77; P = .00). Pulmonary disease (OR 7.49; 95% CI 2.17-25.80; P = .00), not prescribing beta-blockers (OR 4.67; 95% CI 1.28-17.03; P < .02), nonambulatory status (OR 22.99; 95% CI 6.27-84.24; P = .00), and systemic AEs (OR 9.66; 95% CI 1.84-50.57; P < .01) were independent predictors of death. Functional status was not improved in group II after long-term follow-up.CONCLUSION:
Nonambulatory patients suffer from extensive comorbid conditions. They are accompanied with an increased occurrence of AEs, unplanned reinterventions, and poor long-term survival rates. Successful LEAR did not improve their functional status after 6 years. This emphasizes that attempts for limb salvage must be carefully considered in these patients.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Vascular Surgical Procedures
/
Health Status Indicators
/
Lower Extremity
/
Intermittent Claudication
/
Ischemia
Type of study:
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged80
Language:
En
Journal:
J Vasc Surg
Journal subject:
ANGIOLOGIA
Year:
2010
Type:
Article
Affiliation country:
Netherlands