title: Need for late lower limb revascularization and major amputation after coronary artery bypass surgery.
abstract: OBJECTIVE
  The aim of the present study was to estimate the need for late lower limb revascularization and/or major amputation after coronary artery bypass grafting (CABG).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  1307 residents of Oulu who underwent CABG from 1990 to 2006 formed the basis of this community-wide study.
  
  
  RESULTS
  During a mean follow-up of 7.1+/-4.5 years, 111 patients (8.5%) underwent 251 vascular procedures for lower limb ischemia and 25 major amputations. In four patients, revascularization was done for complicated wound after vein graft harvesting. Freedom rates from lower limb revascularization and/or major amputation at 5-, 10- and 15-year were 92.9%, 88.4% and 85.1%, whereas freedom rates from lower limb revascularization for critical ischemia and/or major amputation were 98.1%, 95.2% and 94.7%. Age (p=0.013, HR 1.05), extracardiac arteriopathy (p<0.0001, HR 5.39), left ventricular ejection fraction classes (p=0.03), diabetes (p<0.0001, HR 5.78), and estimated glomerular filtration rate<60mg/min/m(2) (p=0.02, HR 2.22) were independent predictors of lower limb revascularization for critical leg ischemia and/or major amputation.
  
  
  CONCLUSIONS
  Patients with extracardiac arteriopathy, diabetes and decreased glomerular filtration rate at the time of CABG are at risk for late lower limb ischemia. These patients would most benefit of a closer follow-up for prevention of peripheral vascular disease and its related complications.
authors.affiliation: Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
authors.forename: F
authors.initials: F
authors.lastname: Biancari
authors.forename: O-P
authors.initials: OP
authors.lastname: Kangasniemi
authors.forename: M A A
authors.initials: MA
authors.lastname: Mahar
authors.forename: K
authors.initials: K
authors.lastname: Ylönen
mesh_terms: D000671:Amputation, Surgical; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000601:surgery; D014656:Vascular Surgical Procedures