title: Defining risks and predicting adverse events after lower extremity bypass for critical limb ischemia.
abstract: Successful treatment of patients with critical limb ischemia (CLI), hinges on the adequacy of revascularization. However, CLI is associated with a severe burden of systemic atherosclerosis, and patients often suffer from multiple cardiovascular comorbidities. Therefore, CLI patients in general represent a cohort at increased risk for procedural complications and adverse events. Although endovascular therapy represents a minimally invasive alternative to open surgical bypass, the durability of surgical reconstruction is superior, and it remains the "gold standard" approach to revascularization in CLI. Therefore, selection of the optimal treatment modality for individual patients requires careful consideration of the procedural risks and likelihood of adverse events associated with surgery. Individualized decision-making with regard to revascularization strategy requires a comprehensive understanding of the likelihood of adverse outcomes after major surgery. Here we review the risks of surgical bypass in patients with CLI, with particular emphasis on the identification of preoperative variables that predict poor outcome.
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Siracuse
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Zhen S
authors.initials: ZS
authors.lastname: Huang
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gill
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Inkyong
authors.initials: I
authors.lastname: Parrack
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Darren B
authors.initials: DB
authors.lastname: Schneider
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Connolly
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Meltzer
mesh_terms: D016638:Critical Illness; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects*
keywords: adverse events; bypass; critical limb ischemia