Outcomes and practice patterns in patients undergoing lower extremity bypass
Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
Authors
Simons, Jessica P.Schanzer, Andres
Nolan, Brian W.
Stone, David H.
Kalish, Jeffrey A.
Cronenwett, Jack L.
Goodney, Philip P.
UMass Chan Affiliations
Department of Surgery, Division of Vascular and Endovascular SurgeryDocument Type
Journal ArticlePublication Date
2012-06-01Keywords
AgedAged, 80 and over
Amputation
Chi-Square Distribution
*Endovascular Procedures
Female
Hospital Mortality
Humans
Intermittent Claudication
Ischemia
Kaplan-Meier Estimate
Limb Salvage
Linear Models
Lower Extremity
Male
Middle Aged
New England
*Outcome and Process Assessment (Health Care)
*Physician's Practice Patterns
Postoperative Complications
Registries
Reoperation
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
*Vascular Surgical Procedures
Surgery
Metadata
Show full item recordAbstract
BACKGROUND: The appropriate application of endovascular intervention vs bypass for both critical limb ischemia (CLI) and intermittent claudication (IC) remains controversial, and outcomes from large, contemporary series are critical to help inform treatment decisions. Therefore, we sought to define the early and 1-year outcomes of lower extremity bypass (LEB) in a large, multicenter regional cohort, and analyze trends in the use of LEB with or without prior endovascular interventions. METHODS: The Vascular Study Group of New England database was used to identify all infrainguinal LEB procedures performed between 2003 and 2009. The primary study endpoint was 1-year amputation-free survival (AFS). Secondary endpoints included in-hospital mortality and morbidity, including major adverse cardiac events. Trend analyses were conducted to identify annual trends in the proportion of LEBs performed for an indication of IC, in-hospital outcomes, including mortality and morbidity, and 1-year outcomes, including AFS. Analyses were performed on the entire cohort and then stratified by indication. RESULTS: Between 2003 and 2009, 2907 patients were identified who underwent LEBs (72% for CLI; 28% for IC). The proportion that underwent LEB for IC increased significantly over the study period (from 19% to 31%; P < .0001). There was a significant increase over time in the proportion of LEBs performed after a previous endovascular intervention among both CLIs (from 11% to 24%; P < .0001) and ICs (from 13% to 23%; P = .02). Neither in-hospital mortality nor cardiac event rates changed significantly among either group. There was no significant change in 1-year AFS in patients with IC (97% in 2003 and 98% in 2008; P for trend .63) or in patients with CLI (73% in 2003 and 81% in 2008; P = .10). CONCLUSIONS: Over the last 7 years, significant changes in patient selection for LEBs have occurred in New England. The proportion of LEBs performed for ICs as opposed to CLIs has increased. Patients are much more likely to have undergone prior endovascular interventions before undergoing a bypass. In-hospital and 1-year outcomes after LEB for both IC and CLI have remained excellent with no significant changes in AFS. rights reserved.Source
J Vasc Surg. 2012 Jun;55(6):1629-36. Link to article on publisher's site
DOI
10.1016/j.jvs.2011.12.043Permanent Link to this Item
http://hdl.handle.net/20.500.14038/49686PubMed ID
22608039Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.jvs.2011.12.043