The Comprehensive Risk Assessment for Bypass (CRAB) facilitates efficient perioperative risk assessment for patients with critical limb ischemia

Abstract

The CRAB is a CLI-specific, risk assessment instrument derived from multi-institutional American College of Surgeons-National Surgical Quality Improvement Program surgical outcomes data that out-performs existing prognostic risk indices in the prediction of clinically significant adverse events after bypass surgery. Use of the CRAB as a risk assessment tool provides an evidence basis for patient-centered clinical decision making and may have a role in identifying patients at higher risk for surgical revascularization in whom an endovascular approach is preferable.

Assessing the Perioperative Safety of Common Femoral Endarterectomy in the Endovascular Era

“…It is not surprising that functional dependence is a predictor of poor outcomes in CFE as it a known predictor of morbidity and mortality in lower extremity bypass. 21,22 Likewise dyspnea at Abbreviations: CI, confidence interval; OR, odds ratio. rest has also been associated with an increased risk of postoperative mortality.…”

The Role of Infrainguinal Bypass Surgery in the Endovascular Era

“…9) Other authors tried to create a prognostic score for the saphenous vein bypass (CRAB); the considered factors were: age >75 years, prior amputation/revascularization, ulceration, hemodialysis, recent angina, emergent case, partial/total functional dependence. 10) On the other hand, the main factor associated with late failure of prosthetic graft has been supposed to be dependent on the intrinsic thrombogenicity of synthetic materials, along with the miointimal hyperplasia at the anastomotic sites and the progression of atherosclerosis on inflow and outflow vessels.…”

Defining risks and predicting adverse events after lower extremity bypass for critical limb ischemia

“…Our group has previously published a more comprehensive, targeted risk assessment tool to predict 30-day major morbidity and mortality after bypass surgery for CLI; The Comprehensive Risk Assessment for Bypass 6. A review of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) found that the 30-day mortality rate after lower extremity bypass for CLI was 2.9%, with a major morbidity at a rate of 19.1% 6.…”

“…A review of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) found that the 30-day mortality rate after lower extremity bypass for CLI was 2.9%, with a major morbidity at a rate of 19.1% 6. The composite major morbidity and mortality end point was seen in 10.1% of patients.…”

“…Because patients with CLI commonly suffer from associated comorbidities, they represent a “high risk” cohort, in which adverse events are not uncommon. Multiple studies have suggested that perioperative mortality exceeds 2%, with complication rates exceeding 20% in some groups 6,7…”