title: Revascularization for peripheral vascular disease in Aboriginal and non-Aboriginal patients.
abstract: BACKGROUND
  Canadian Aboriginal subjects have a higher prevalence of diabetes, renal disease, and lower extremity amputation than non-Aboriginal subjects. However, limited information is available about patient outcomes for arterial bypass surgery in Canadian Aboriginal compared with non-Aboriginal subjects.
  
  
  METHODS
  A retrospective study of all patients undergoing revascularization for peripheral vascular disease at a tertiary care referral center was performed.
  
  
  RESULTS
  A total of 828 procedures were performed on 678 patients between 1995 and 2002: 108 (13%) procedures on 84 (12%) Aboriginal patients and 720 (87%) procedures on 594 (88%) non-Aboriginal patients. Aboriginal patients had a higher prevalence of diabetes, chronic renal failure, and end-stage renal disease than non-Aboriginal patients. Aboriginal patients presented with more serious complications (gangrene [Aboriginal, 63 [58%] of 108 patients; non-Aboriginal, 112 [16%] of 720 patients; P < .0001] and nonhealing ulcer [Aboriginal, 29 [27%] of 108 patients; non-Aboriginal, 131 [18%] of 720 patients; P < .05]) and required urgent or emergency revascularization (Aboriginal, 47 [49%] of 95 patients; non-Aboriginal, 228 [36%] of 634 patients; P < .02) more frequently than non-Aboriginal patients. The 60-month patient mortality was similar for both groups (Aboriginal, 20 [24%] of 84 patients; non-Aboriginal, 160 [27%] of 594 patients; not significant), but Aboriginal patients had loss of limb more frequently (Aboriginal, 19 [18%] of 108 patients; non-Aboriginal, 62 [9%] of 720 patients; P < .0001) and had loss of primary graft patency more frequently (Aboriginal, 39 [36%] of 108 patients; non-Aboriginal, 155 [22%] of 720 patients; P < .0001) than non-Aboriginal patients.
  
  
  CONCLUSIONS
  Canadian Aboriginal subjects had worse outcomes with revascularization than non-Aboriginal subjects, but ethnicity and diabetes were not independent risk factors for poor outcome. Multivariate analysis showed that the poor outcomes in mortality, limb salvage, and primary graft patency among Aboriginal patients undergoing revascularization may be attributed to renal disease and a more advanced mode of presentation of peripheral vascular disease complications at the time of intervention.
authors.affiliation: Department of Medicine, University of Manitoba, Winnipeg, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Goulet
authors.forename: Elly
authors.initials: E
authors.lastname: Trepman
authors.forename: Mary Cheang
authors.initials: MC
authors.lastname: Mmath
authors.forename: Joshua
authors.initials: J
authors.lastname: Koulack
authors.forename: Hank
authors.initials: H
authors.lastname: Fong
authors.forename: Frank
authors.initials: F
authors.lastname: Duerksen
authors.forename: Bruce
authors.initials: B
authors.lastname: Martin
authors.forename: J Neil
authors.initials: JN
authors.lastname: Simonsen
authors.forename: Lindsay
authors.initials: L
authors.lastname: Nicolle
authors.forename: John
authors.initials: J
authors.lastname: Embil
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000601:surgery*; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality