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Vascular morbidity and mortality during long-term follow-up in claudicants selected for peripheral bypass surgery
I Dawson1, R B Sie, E E van der Wall
1Department of Surgery, University Hospital Leiden, The Netherlands.
Insights
Peripheral bypass surgery for claudicants carries risks of vascular events and mortality. Identifying high-risk patients is crucial for appropriate surgical selection.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Patient Risk Stratification
Background:
- Peripheral bypass surgery is performed for claudication, but long-term outcomes require evaluation.
- Identifying patients at risk for vascular morbidity and mortality post-surgery is essential.
Purpose of the Study:
- To identify claudicants at high and low risk of late vascular morbidity and mortality after peripheral bypass surgery.
Main Methods:
- Prospective cohort study with a mean follow-up of 8.6 years.
- 155 claudicants undergoing peripheral bypass surgery were analyzed.
- Endpoints included major vascular events, interventions, mortality, and functional outcomes.
Main Results:
- Annual risk for major vascular events was 3.5%.
- Hypertension, diabetes, and cardiac disease were strong predictors of vascular events.
- Cardiac disease and diabetes significantly increased mortality risk.
Conclusions:
- Major vascular events and interventions are frequent in claudicants post-surgery.
- Risk factors like hypertension, diabetes, and cardiac disease predict adverse outcomes.
- Selecting low-risk patients can justify peripheral bypass surgery.
Objectives:
To identify claudicants at high risk (and low risk) of late vascular morbidity and mortality after peripheral bypass surgery.
Design:
Prospective cohort study with mean follow-up of 8.6 years.
Patients:
One-hundred and fifty-five claudicants selected for peripheral bypass surgery. Only three patients were lost to follow-up. End points were major vascular events, additional interventions, all-cause mortality, and functional outcome.
Results:
Major vascular events occurred in 59 patients. Life-table analysis revealed an annual risk increase of 3.5%. Strong predictors were hypertension (hazard ratio (HR) 2.7; 95% confidence interval (CI) 1.5-4.8), diabetes (HR 2.4; 95% CI 1.0-5.4) and cardiac disease (HR 2.2; 95% CI 1.2-4.0). Sixty patients needed additional interventions with a highest incidence (17%) in the first year, and thereafter 2.8% each year. None of the known risk factors were associated with an altered incidence of interventions. Approximately 3.5% of patients died per year compared with 2% per year in the control group. Prominent high-risk factors for mortality were cardiac disease (HR 3.3; 95% CI 1.8-6.0) and diabetes (HR 3.0; 95% CI 1.5-7.1).
Conclusion:
Major vascular events and additional interventions are common and serious in claudicants. However, it is possible to select low-risk patients in which peripheral bypass surgery is justified.