title: Limits of infrainguinal bypass surgery for critical leg ischemia in high-risk patients (Finnvasc score 3-4).
abstract: BACKGROUND
  The aim of the present study was to compare the early- and midterm outcomes after infrainguinal bypass surgery in the treatment of low- and high-risk patients with critical limb ischemia (CLI) (Finnvasc score 0-2 and 3-4, respectively), and to evaluate limits of infrainguinal bypass surgery in treatment of the latter group.
  
  
  METHODS
  Two hundred seventy-four infrainguinal bypass procedures performed in 218 patients were retrospectively reviewed. The Finnvasc score (range: 0-4) was calculated by assigning one point to each of four preoperative risk factors, that is, coronary artery disease, diabetes, urgency of the procedure, and gangrene. Major outcome end points were survival, limb salvage, and amputation-free survival.
  
  
  RESULTS
  Among 274 infrainguinal bypass procedures performed for CLI, 92 procedures (33.6%) were performed in patients with Finnvasc score 3-4. They had significantly lower leg salvage (at 3-year follow-up, 53.7 vs. 70.6%; log-rank: p = 0.004), survival (at 3-year follow-up, 49.7 vs. 69.7%; log-rank: p < 0.0001), and amputation-free survival (at 3-year follow-up, 27.7 vs. 53.1%; log-rank: p < 0.0001) compared with patients with Finnvasc score 0-2. Patients with Finnvasc score 3-4 and a preoperative serum creatinine level of >150 μmol/L had 1-year amputation-free survival of 12.5%, whereas patients with lower level of creatinine had 1-year amputation-free survival of 53.1% (p = 0.028).
  
  
  CONCLUSIONS
  Infrainguinal bypass revascularization in CLI patients who present with Finnvasc score 3-4 can be considered at higher risk of poor intermediate outcome in terms of survival, leg salvage, and amputation-free survival. Poor outcome is particularly expected in patients with Finnvasc score 3-4 and renal failure. In this subgroup of patients, primary amputation should be considered.
authors: Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland. aristotelis.kechagias@yahoo.gr
authors: Aristotelis
authors: A
authors: Kechagias
authors: Kari
authors: K
authors: Ylönen
authors: Georgios
authors: G
authors: Kechagias
authors: Tatu
authors: T
authors: Juvonen
authors: Fausto
authors: F
authors: Biancari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016009:Chi-Square Distribution; D016638:Critical Illness; D018572:Disease-Free Survival; D005260:Female; D005387:Finland; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000150:complications; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality