Defining risks and predicting adverse events after lower extremity bypass for critical limb ischemia

Figures & data

Table 1 Perioperative risk assessment strategies

Model	Variables	Comment
American Society of Anesthesiology (ASA)	Degree of systemic disease	Assess overall fitness for surgery
American College of Surgeons Risk Calculator	Age, sex, BMI, ASA class, functional status, case urgency, wound class, steroid use, ascites, sepsis, ventilated, disseminated cancer, diabetes, hypertension, previous cardiac event, CHF, dyspnea, smoker, COPD, dialysis, ARF	Assess risks for perioperative mortality as well as specific complications
Surgical Risk Score	Case urgency, ASA class, case complexity	Predicts mortality and major morbidity
Revised Cardiac Risk Index	CAD, CHF, history of CVA/TIA, diabetes, CRI, intra-abdominal/intra-thoracic surgery	Risk of cardiac death, nonfatal myocardial infarction, and nonfatal cardiac arrest
PREVENT III	Dialysis, CAD, tissue loss, anemia, age	Predictor of death or major amputation in 1 year
VSGNE	Age, smoking, beta-blocker use, COPD, CRI, CHF, CAD, diabetes	Risk of perioperative cardiac events
Comprehensive Risk Assessment for Bypass (CRAB)	Age, dialysis dependence, tissue loss, functional status, severe cardiac disease, emergency operation, prior amputation/revascularization	Predictor of 30-day major morbidity and mortality

Abbreviations: ARF, acute renal failure; BMI, body mass index; CAD, coronary artery disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CRI, chronic renal insufficiency; CVA, cerebrovascular accident; PREVENT, PRoject of Ex vivo vein GRaft Engineering via Transfection; VSGNE, Vascular Study Group of New England; TIA, transient ischemic attack.

Table 2 Shared high risk groups

Coronary artery disease

Dialysis dependence

Advanced age

Impaired functional status

Tissue loss

Emergency operation

Congestive heart failure

Smoking

Chronic obstructive pulmonary disease

Table 3 Subgroup patency

Demographic	Patency rate	CLI	Tibial target	Duration of follow-up
Octogenarians	72%	96%	76%	5 years^Citation18
Younger than 40	52%	87%	46%	5 years^Citation20
African-American	52%	91%	67%	5 years^Citation23
Renal transplant	44%	95%	78%	5 years^Citation26
Arm vein conduit	52%	99%	84%	3 years^Citation27
Prosthetic conduit	60%	96%	100%	5 years^Citation28
Severely calcified target	60%	90%	100%	2 years^Citation29

Abbreviation: CLI, critical limb ischemia.

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