Vascular morbidity and mortality during long-term follow-up in claudicants selected for peripheral bypass surgery.
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.
Dawson
I
I
Department of Surgery, University Hospital Leiden, The Netherlands.
Sie
R B
RB
van der Wall
E E
EE
Brand
R
R
van Bockel
J H
JH
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