PMID- 30497863 OWN - NLM STAT- MEDLINE DCOM- 20191118 LR - 20221207 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 69 IP - 6S DP - 2019 Jun TI - Survival prediction in patients with chronic limb-threatening ischemia who undergo infrainguinal revascularization. PG - 137S-151S.e3 LID - S0741-5214(18)32236-5 [pii] LID - 10.1016/j.jvs.2018.08.169 [doi] AB - OBJECTIVE: Accurate survival prediction critically influences decision-making in caring for patients with chronic limb-threatening ischemia (CLTI). The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial demonstrated that in patients who survived >2 years, there was a significant advantage to infrainguinal bypass compared with endovascular intervention, which increased with time. Validated survival models for patients with CLTI are lacking. METHODS: The Vascular Quality Initiative was interrogated for patients who underwent infrainguinal bypass or endovascular intervention for CLTI (January 2003-February 2017). Cox survival models were generated using only preoperative variables. Survival at 30 days, 2 years, and 5 years was modeled separately. Patients were defined as low risk (30-day survival >97% and 2-year survival >70%), medium risk (30-day survival 95%-97% or 2-year survival 50%-70%), and high-risk (30-day survival <95% or 2-year survival <50%). RESULTS: Among 38,470 unique CLTI patients, 63% (n = 24,214) underwent endovascular intervention and 37% (n = 14,256) underwent infrainguinal bypass. Kaplan-Meier estimates of overall survival at 30 days, 2 years, and 5 years were 98%, 81%, and 69%, respectively. The proportion of patients in the low-, medium-, and high-risk groups was 84%, 10%, and 6.5%, respectively. Patients in the low-risk group were significantly less likely to undergo endovascular intervention compared with those in the high-risk group (low risk, 59% endovascular; high risk, 75% endovascular; P < .0001). Independent predictors of death were similar in all three models, with greatest magnitude of effect associated with age >80 years, oxygen-dependent chronic obstructive pulmonary disease, stage 5 chronic kidney disease, and bedbound status. The C index for the 30-day model, 2-year model, and 5-year model was 0.76, 0.72, and 0.71, respectively. Procedure type (open or endovascular) was not significant in any models and did not have an impact on C indices. CONCLUSIONS: These survival prediction models, derived from a large U.S. cohort of patients who underwent revascularization for CLTI, demonstrated good performance and should be validated. Most CLTI patients considered candidates for limb salvage were of average perioperative risk and were predicted to survive beyond 2 years. These models can differentiate patients into low-, medium-, and high-risk groups to facilitate evidence-based revascularization recommendations that are consistent with current treatment guidelines. CI - Copyright (c) 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Simons, Jessica P AU - Simons JP AD - Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass. Electronic address: jessica.simons@umassmemorial.org. FAU - Schanzer, Andres AU - Schanzer A AD - Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass. FAU - Flahive, Julie M AU - Flahive JM AD - Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass. FAU - Osborne, Nicholas H AU - Osborne NH AD - Section of Vascular Surgery, University of Michigan Medical School, Ann Arbor, Mich. FAU - Mills, Joseph L Sr AU - Mills JL Sr AD - Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex. FAU - Bradbury, Andrew W AU - Bradbury AW AD - Department of Vascular Surgery, University of Birmingham, Birmingham, United Kingdom. FAU - Conte, Michael S AU - Conte MS AD - Division of Vascular and Endovascular Surgery, Cardiovascular Research Institute, University of California, San Francisco, Calif. LA - eng PT - Comparative Study PT - Journal Article DEP - 20181126 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Aged MH - Aged, 80 and over MH - Amputation, Surgical MH - Blood Vessel Prosthesis MH - *Blood Vessel Prosthesis Implantation/adverse effects/instrumentation/mortality MH - Chronic Disease MH - Databases, Factual MH - *Endovascular Procedures/adverse effects/instrumentation/mortality MH - Female MH - Humans MH - Ischemia/diagnosis/mortality/physiopathology/*therapy MH - Limb Salvage MH - Male MH - Middle Aged MH - Peripheral Arterial Disease/diagnosis/mortality/physiopathology/*therapy MH - Progression-Free Survival MH - Registries MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Stents MH - Time Factors MH - Vascular Patency OTO - NOTNLM OT - Chronic limb-threatening ischemia OT - Survival OT - Vascular Quality Initiative EDAT- 2018/12/01 06:00 MHDA- 2019/11/19 06:00 CRDT- 2018/12/01 06:00 PHST- 2018/03/09 00:00 [received] PHST- 2018/08/01 00:00 [accepted] PHST- 2018/12/01 06:00 [pubmed] PHST- 2019/11/19 06:00 [medline] PHST- 2018/12/01 06:00 [entrez] AID - S0741-5214(18)32236-5 [pii] AID - 10.1016/j.jvs.2018.08.169 [doi] PST - ppublish SO - J Vasc Surg. 2019 Jun;69(6S):137S-151S.e3. doi: 10.1016/j.jvs.2018.08.169. Epub 2018 Nov 26.