title: Vascular morbidity and mortality during long-term follow-up in claudicants selected for peripheral bypass surgery.
abstract: OBJECTIVE
  To identify claudicants at high risk (and low risk) of late vascular morbidity and mortality after peripheral bypass surgery.
  
  
  METHODS
  Prospective cohort study with mean follow-up of 8.6 years.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, University Hospital Leiden, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Dawson
authors.forename: R B
authors.initials: RB
authors.lastname: Sie
authors.forename: E E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: R
authors.initials: R
authors.lastname: Brand
authors.forename: J H
authors.initials: JH
authors.lastname: van Bockel
mesh_terms: D001166:Arteriovenous Shunt, Surgical; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D011446:Prospective Studies; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome