Mortality following operations for lower extremity peripheral arterial disease

Abstract

Background

We sought to identify risk factors associated with mortality following surgery for peripheral arterial disease (PAD).

Methods

We evaluated the association between levels of control of atherosclerotic risk factors and time to mortality following either lower extremity bypass surgery or lower extremity amputation using Cox proportional hazards regression.

Results

Among 796 patients with PAD (defined by an ankle-brachial index [ABI] < 0.9), 230 (28.9%) underwent an operation for PAD (136, lower-extremity bypasses; 111, lower-extremity amputations). Participants were followed for up to six years after their diagnosis of PAD. A total of 107 (46.5% of the 230) died during the period of follow-up. Factors associated with mortality following lower extremity bypass surgery included age 70 years and older hazard ratio [HR] 1.88; 95% confidence interval [CI]: 1.01–3.51) and of African American race (HR 1.94; 95% CI: 1.04–3.62). Renal insufficiency was significantly associated with mortality following lower extremity amputation (HR 2.19; 95% CI: 1.16–4.13).

Conclusion

Our data provide information on preoperative risk variables to consider when assessing long-term mortality in persons with PAD who are undergoing surgery for PAD.

Keywords:

• risk factors
• mortality
• bypass surgery
• ankle-brachial index

Acknowledgments/disclosures

This work was supported by an Investigator-Initiated Grant (#01-180-1; Principal Investigator, Dr Tracie C Collins) from Department of Veterans Affairs, Health Services Research and Development along with resources from the Houston Center for Quality of Care and Utilization Studies, Michael E DeBakey Veterans Affairs Medical Center. Dr Collins was a recipient of the Department of Veterans Affairs Advanced Clinical Research Career Development Award at the time the data for this work was collected. The authors report no conflicts of interest with this work.