Very late survival after vascular surgery.
OBJECTIVE
The aim of this study was to define very late survival in veterans who routinely underwent preoperative assessment of left ventricular function using radionuclide ventriculography (RNVG) before elective major vascular surgery from 7/84 to 7/88 at one Veterans Affairs Medical Center.


METHODS
RNVG defined left ventricular ejection fraction (EF) and determined the presence of ventricular wall motion abnormalities. Patients undergoing elective vascular surgery (n = 310) who had preoperative RNVG were then followed over the years using direct contact, VA administrative databases, and, most recently, the Social Security Death Index.


RESULTS
Follow-up was 6.64 +/- 4.62 years (range 0 to 16.2 years). Current survival is 10% (11/107) after carotid surgery, 12% (10/82) after aortic aneurysm repair, 15% (17/111) after extremity reconstruction, and 0% (0/10) after visceral artery reconstruction (ns). There was no statistically significant difference in mortality between the different types of vascular surgery at 30 days or at 1, 5, and 10 years after surgery (ns). Actual survival rates at 5 years after carotid surgery, aneurysm repair, extremity reconstruction, and visceral reconstruction were 55, 61, 59, and 50%, respectively. Stepwise logistic regression analysis was performed which included preoperatively defined cardiovascular risk factors, type of surgery, and results of RNVG. The final regression model indicated that age, diabetes, smoking at the time of surgery, and low EF were independently associated with overall mortality while angina, prior myocardial infarction (MI), and type of operation were not. Mean survival duration with normal EF (>50%) was 7.99 years versus 4.78 years with low EF (P < 0.001). No patient with severe left ventricular dysfunction (EF < or = 35%; n = 39) or who had postoperative cardiac complications (MI, CHF, ventricular arrhythmia; n = 38) survived to the present.


CONCLUSIONS
Very late survival after major vascular surgery was related to the presence of diabetes, active smoking at the time of surgery, left ventricular function, and postoperative cardiac complications. Since there was no association of overall mortality with angina or prior MI, an aggressive approach to coronary evaluation in such patients might not alter very late survival.
Division of Vascular Surgery, Wayne State University School of medicine, Detroit, MI 48201, USA.
Andris
A
Kazmers
Ted R
TR
Kohler
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000601:surgery; D003925:Diabetic Angiopathies / Q000601:surgery; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D009203:Myocardial Infarction; D015635:Radionuclide Ventriculography; D012907:Smoking / Q000009:adverse effects; D013318:Stroke Volume; D016019:Survival Analysis; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016277:Ventricular Function, Left; D014728:Veterans