Ann D. Smith1, Maria J. Schaumeier2, Alexander T. Hawkins3, Nathanael D. Hevelone2, Louis L. Nguyen1
1Brigham and Women's Hospital, Boston, MA; 2Center for Surgery and Public Health, Boston, MA; 3Massachusetts General Hospital, Boston, MA.
OBJECTIVES: Despite patent bypass grafts, some patients receive major amputations (MA). We analyzed the frequency and predictive factors leading to MA in the presence of patent lower extremity bypass grafts (LEB).
METHODS: Data from PREVENT III, a large prospective randomized trial of 1,404 patients who underwent LEB for critical limb ischemia (CLI) was queried for outcomes. The primary endpoint was MA with patent (PMA) or occluded (OMA) LEB. Variables identified on univariate analysis (inclusion threshold p<0.08) were included in a multivariable logistic regression model to identify independent predictors.
RESULTS: Of 1,404 LEB patients, 162 (11.5%) had MA, 89 (6.3%) with patent and 73 (5.2%) with occluded LEB.
For PMA, 21 (23.6%) had critical graft stenosis, of which 17 (81.0%) underwent revision, with mean time to revision of 50.76 days (SD+/-55.49). Minority race (OR 2.69, CI 1.28-5.66, p=0.0092), diabetes (OR 4.14, CI 1.20-14.24, p=0.025), lower baseline activity score (OR 1.92, CI 1.24-2.98, p=0.0036), and negative change in 3-month activity (OR 1.61, CI 1.22-2.13, p=0.0007) were predictors for PMA, while tissue loss was not predictive (OR 2.32, CI 0.66-8.08, p=0.19). For OMA, 64 (87.7%) had critical graft stenosis but only 35 (54.7%) underwent revision, with mean time to revision of 76.11 days (SD+/-80.14) and mean time to MA of 107.37 days (SD+/-103.39).
CONCLUSIONS: PMA patients had lower rates of graft stenosis, but were revised earlier than their OMA counterparts. Non-graft-related factors (demographic and functional activity) also influenced PMA. Further investigation into PMA may optimize treatment decisions.
AUTHOR DISCLOSURES: A. T. Hawkins: Nothing to disclose; N. D. Hevelone: Nothing to disclose; L. L. Nguyen: Nothing to disclose; M. J. Schaumeier: Nothing to disclose; A. D. Smith: Nothing to disclose.
Posted April 2013