title: Validation of the Guy's scoring system in patient selection for femoro-distal bypass grafting to a single calf or pedal artery.
abstract: OBJECTIVE
  First external validation of a preoperative scoring system (Guy's) in patient selection for femoro-distal bypass grafting to single calf or pedal artery in critical limb ischemia (Fontaine III & IV/Rutherford grade IV, V & VI).
  
  
  METHODS
  A prospective study of 76 (n = 76) consecutive femoro-crural/pedal bypass grafts on 72 individuals (n = 72) from 2008 to 2011 with 36 months mean follow-up was performed. All cases were scored against a previously designed and published scoring system (ranging from 0 to 10) based on: inflow, outflow, graft material, flow type, patent pedal vessels and diabetes mellitus.
  
  
  RESULTS
  Preoperative score of 0-4 (n = 37) demonstrated the primary patency of 27% at 10.3 months. This value for intermediate group 5-7 (n = 34) was 70.6% at 18.9 months. The high-score group 8-10 (n = 4) showed the longest primary patency (80%) at 27.3 months. Kaplan-Meier survival analysis exhibited a consistent and significant difference in primary assisted, secondary patency and overall limb/foot salvage amongst all individual scoring groups (p < 0.001).
  
  
  CONCLUSIONS
  This study validates and complements the Guy's scoring system and provides a platform for the identification of critical limb ischemia patients in whom the result of femoro-crural/distal bypass grafting is so poor that primary amputation may be both clinically and economically more justified.
authors.affiliation: Department of Vascular and Endovascular Surgery, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Essex, UK Alikordzadeh@gmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Kordzadeh
authors.affiliation: Department of Vascular and Endovascular Surgery, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Essex, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Askari
authors.affiliation: Department of Vascular and Endovascular Surgery, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Essex, UK.
authors.forename: Yiannis P
authors.initials: YP
authors.lastname: Panayiotopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D016638:Critical Illness; D003661:Decision Support Techniques; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*; D055815:Young Adult
keywords: Critical limb ischemia; Guy’s scoring validation; bypass grafting; femoro-crural bypass; femoro-distal bypass; scoring system