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Determining the Functional Status of the Corticospinal Tract Within One Week of Stroke

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Predicting ambulation status one year after lower extremity bypass.

Philip P Goodney¹, Donald S Likosky, Jack L Cronenwett

¹Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03765, USA. philip.goodney@hitchcock.org

Journal of Vascular Surgery

|June 6, 2009

Summary

This summary is machine-generated.

Lower extremity bypass (LEB) surgery generally preserves patient ambulation, but outcomes depend on factors like age and preoperative mobility. A predictive model helps surgeons assess the likelihood of remaining ambulatory one year after LEB.

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Area of Science:

Vascular Surgery
Patient Outcomes
Predictive Modeling

Background:

Lower extremity bypass (LEB) surgery involves weighing morbidity against functional outcomes.
Predicting postoperative ambulation status is crucial for patient selection and management.

Purpose of the Study:

To develop and validate a predictive model for ambulation status one year after LEB.
To identify key predictors influencing long-term functional outcomes post-LEB.

Main Methods:

Analysis of a prospective registry of 1561 LEB procedures in 1400 patients.
Assessment of ambulation status preoperatively, at discharge, and one year postoperatively.
Utilized Cox proportional hazards models to identify predictors of 1-year ambulation.

Main Results:

Claudicant patients demonstrated superior graft patency and 1-year ambulatory rates (96%) compared to critical limb ischemia (CLI) patients (81%).
Preoperative non-ambulation, advanced age, CLI, postoperative myocardial infarction, and major amputation increased the risk of being nonambulatory at 1 year.
Graft thrombosis and preoperative nursing home residence were independently associated with higher risks of non-ambulatory status.

Conclusions:

Ambulatory and independent living status are generally well-preserved after LEB.
Preoperative factors including age, ambulatory ability, independent living status, CLI, graft patency, and amputation are significant predictors of 1-year ambulatory status.
A predictive model incorporating these risk factors can inform surgical decision-making for LEB.