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Absolute Lymphocyte Count Predicts Bypass Surgery Outcomes in Patients with Chronic Limb-Threatening Ischemia

Satoshi Yamamoto1,2, Takuya Hashimoto1, Masaya Sano1

  • 1Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.

Annals of Vascular Diseases
|June 26, 2024
PubMed

Insights

Higher absolute lymphocyte counts (ALC) correlate with improved survival and limb salvage after infrainguinal bypass surgery for chronic limb-threatening ischemia (CLTI). ALC shows promise as a prognostic marker, especially for hemodialysis patients.

Area of Science:

  • Vascular Surgery
  • Immunology
  • Clinical Outcomes Research

Background:

  • Chronic limb-threatening ischemia (CLTI) poses significant risks for limb loss and mortality.
  • Infrainguinal bypass surgery is a critical intervention for CLTI, but outcomes can vary.
  • Predictive markers for surgical success in CLTI patients are essential for optimizing treatment strategies.

Purpose of the Study:

  • To investigate the association between preoperative absolute lymphocyte count (ALC) and outcomes following infrainguinal bypass surgery in patients with CLTI.
  • To determine if ALC can serve as a prognostic indicator for patient survival and limb salvage.
  • To specifically evaluate the role of ALC in predicting outcomes for CLTI patients undergoing bypass surgery, particularly those on dialysis.

Main Methods:

  • A retrospective analysis of 209 limbs from 189 patients who underwent infrainguinal bypass for CLTI between 2004 and 2020.
  • Calculation of ALC cut-off values to stratify patients into higher and lower ALC groups based on survival and limb salvage rates (>2 years).
  • Multivariate analysis to assess the independent association of preoperative ALC with limb loss.

Main Results:

  • Patients in the higher ALC group demonstrated significantly higher survival rates (cut-off 1030/μL, p=0.0009) and limb salvage rates (cut-off 1260/μL, p=0.0081) compared to the lower ALC group.
  • In the subgroup of 103 dialysis patients, a higher ALC (cut-off 1170/μL) was significantly associated with better limb salvage rates (p=0.026).
  • Multivariate analysis confirmed that ALC is an independent predictor of limb loss.

Conclusions:

  • Absolute lymphocyte count (ALC) is a valuable and promising predictor of outcomes, including survival and limb salvage, after infrainguinal bypass surgery for CLTI.
  • ALC is particularly useful for predicting limb prognosis in patients with CLTI who are undergoing hemodialysis.
  • Preoperative ALC assessment can aid in risk stratification and patient management for infrainguinal bypass surgery in CLTI.

Keywords:
absolute lymphocyte countbypass surgerychronic limb-threatening ischemia

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