Mortality following operations for lower extremity peripheral arterial disease

Collins, '

doi:10.2147/vhrm.s8899

Cited by 23 publications

(11 citation statements)

References 32 publications

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“…Similar to other reports of risk factors for mortality in this population, 17,[26][27][28][29] increasing age, worsening chronic kidney disease, and worsening functional status were important predictors of worse outcomes. Our model differed from these previous reports in terms of the cohort studied; that is, our study was confined to CLTI patients who underwent vascular interventions and included both open and endovascular revascularization strategies.…”

Section: Discussionsupporting

confidence: 87%

Survival prediction in patients with chronic limb-threatening ischemia who undergo infrainguinal revascularization

Simons

Schanzer

Flahive

et al. 2019

European Journal of Vascular and Endovascular Surgery

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ARTICLE HIGHLIGHTSType of Research: Retrospective analysis of prospectively collected Vascular Quality Initiative data Take Home Message: Endovascular interventions or infrainguinal bypasses were performed in >38,000 patients with chronic limb-threatening ischemia, with 30-day, 2-year, and 5-year survivals of 98%, 81%, and 69%. Patients were placed in low-, medium-, or high-risk groups, and all models had similar predictors of death, namely, age >80 years, oxygen-dependent pulmonary disease, severe renal dysfunction, and bedbound status.Recommendation: The study proposes survival prediction models for patients with chronic limb-threatening ischemia based on Vascular Quality Initiative data. These models require prospective validation.Objective: Accurate survival prediction critically influences decision-making in caring for patients with chronic limbthreatening ischemia (CLTI). The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial demonstrated that in patients who survived >2 years, there was a significant advantage to infrainguinal bypass compared with endovascular intervention, which increased with time. Validated survival models for patients with CLTI are lacking. Methods: The Vascular Quality Initiative was interrogated for patients who underwent infrainguinal bypass or endovascular intervention for CLTI (January 2003-February 2017). Cox survival models were generated using only preoperative variables. Survival at 30 days, 2 years, and 5 years was modeled separately. Patients were defined as low risk (30-day survival >97% and 2-year survival >70%), medium risk (30-day survival 95%-97% or 2-year survival 50%-70%), and high-risk (30-day survival <95% or 2-year survival <50%). Results: Among 38,470 unique CLTI patients, 63% (n ¼ 24,214) underwent endovascular intervention and 37% (n ¼ 14,256) underwent infrainguinal bypass. Kaplan-Meier estimates of overall survival at 30 days, 2 years, and 5 years were 98%, 81%, and 69%, respectively. The proportion of patients in the low-, medium-, and high-risk groups was 84%, 10%, and 6.5%, respectively. Patients in the low-risk group were significantly less likely to undergo endovascular intervention compared with those in the high-risk group (low risk, 59% endovascular; high risk, 75% endovascular; P < .0001). Independent predictors of death were similar in all three models, with greatest magnitude of effect associated with age >80 years, oxygen-dependent chronic obstructive pulmonary disease, stage 5 chronic kidney disease, and bedbound status. The C index for the 30-day model, 2-year model, and 5-year model was 0.76, 0.72, and 0.71, respectively. Procedure type (open or endovascular) was not significant in any models and did not have an impact on C indices. Conclusions: These survival prediction models, derived from a large U.S. cohort of patients who underwent revascularization for CLTI, demonstrated good performance and should be validated. Most CLTI patients considered candidates for limb salvage were of average perioperative risk and were predict...

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Section: Discussionsupporting

confidence: 87%

Survival prediction in patients with chronic limb-threatening ischemia who undergo infrainguinal revascularization

Simons

Schanzer

Flahive

et al. 2019

European Journal of Vascular and Endovascular Surgery

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“…Our findings offer new perspectives compared with previous studies, even in light of possible limitations in terms of external validity. We have focused on a target population to identify the best treatment in elderly patients with a high surgical risk, 27 moderate to severe disabilities, and other comorbidities. The choice of this subset of the population with PAD is related to the prevalence of this disease among the elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Structured Home-Based Exercise Versus Invasive Treatment

et al. 2016

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We compared the effects of an original structured home-based exercise program and revascularization in elderly patients with peripheral arterial disease over a 4-month period. Twenty-seven participants (n = 21; age = 68 ± 7 years) with moderate to severe claudication were randomized into (1) a test in-train out group (Ti-To; n = 18) that performed a home-based walking program prescribed and controlled at the hospital or (2) a revascularization group (Rev; n = 9) that underwent an endovascular and/or surgical procedure. The primary end point was quality of life as evaluated by the physical component summary (PCS) score of the Medical Outcomes Study Short Form 36 questionnaire. Secondary outcome measures included initial claudication distance (ICD) and absolute claudication distance (ACD), 6-minute walk distance (6MWD) and pain-free walk distance (PFWD), ankle-brachial index (ABI), and cost per walking meter gained. The PCS score significantly increased for both treatments at follow-up without a significant intergroup difference, as did ICD, ACD, and PFWD. The 6MWD and ABI significantly improved in the Rev group, and the Ti-To group exhibited a markedly lower cost per meter gained. The comparable effects of the 2 treatments need to be confirmed in a larger, randomized controlled trial.

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“…5,13 Unlike our study, others have also shown a similar association for renal dysfunction generally. 5,14,15 This may be due to variable definitions of renal dysfunction. We used a very broad threshold of serum creatinine (Cr) > 1.5.…”

Section: Discussionmentioning

confidence: 99%