SLR - February 2010 - Jason Neufeld
Reference:
Goodney, P.P, Nolan, B.W., Schanzer A., et al. (2009). Factors associated with amputation or graft occlusion one year after lower extremity bypass in northern New England. Annals of Vascular Surgery, (published online Sept. 11, 2009) 1-12.
Scientific Literature Reviews
Reviewed by: Jason Neufeld DPM
Residency Program: Kaiser Foundation, Hayward/Fremont
Podiatric Relevance:
This article is relevant to our specialty because it allows us to further educate our patients with peripheral arterial disease about the likelihood for lower extremity amputation following revascularization when they present with certain risk factors.
Methods:
2306 lower extremity bypass procedures were studied involving 2031 patients between January 2003 and December 2007 in 11 hospitals in northern New England. Sixty surgeons contributed to the database and over 100 demographic and clinical variables were analyzed. Cox proportional hazards models were utilized in developing hazard ratios and confidence intervals for the combined outcome measure of major amputation or permanent graft occlusion occurring within the first year postoperatively.
Results:
17% of the cohort of 2306 bypass procedures resulted in amputation or graft occlusion within the first year of surgery. Of the 143 amputations, 17% occurred in the setting of a patent graft. Similarly, 42% of the 277 graft occlusions resulted in a major amputation. Using multivariate analysis, eight pre-operative patient characteristics related to amputation or graft occlusion were identified: age<50, nonambulatory status preoperatively, dialysis dependence, diabetes, critical limb ischemia, need for venovenostomy, tarsal target and living in a nursing home preoperatively. Patients with no risk factors had a one year amputation/occlusion rates that were <1%. However, patients with three or more risk factors had almost a 30% chance of amputation or graft occlusion by one year postoperatively.
Conclusions:
Knowledge of preoperative risk factors will allow surgeons to predict risk of graft occlusion or amputation following lower extremity bypass and to more accurately inform patients about their operative risks and likely functional outcomes.