PMID- 34902471
OWN - NLM
STAT- MEDLINE
DCOM- 20220628
LR  - 20221207
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 83
DP  - 2022 Jul
TI  - Prognostic Significance of Preoperative Functional Independence Measure (FIM) on 
      Long-Term Outcomes in Patients with Chronic Limb-Threatening Ischemia (CLTI).
PG  - 275-283
LID - S0890-5096(21)00915-8 [pii]
LID - 10.1016/j.avsg.2021.10.064 [doi]
AB  - BACKGROUND: The purpose of this study was to evaluate the effect of preoperative 
      motor and cognitive activities of daily living (ADL) on long-term outcomes of 
      patients with chronic limb-threatening ischemia (CLTI) after distal bypass. 
      METHODS: A retrospective review was performed for patients who underwent distal 
      bypass for CLTI from 2013 to 2019 at multiple centers in Japan. Comparisons were 
      made among patients with high and low motor and cognitive ADL based on the 
      functional independence measure (FIM). The primary endpoint was limb salvage and 
      the secondary endpoints were survival, amputation free survival (AFS), major 
      adverse limb events (MALE), readmission, and wound healing. RESULTS: A total of 
      226 distal bypasses were performed in 185 patients (169 males; median age, 76 
      years; diabetes mellitus, 70%; end-stage renal disease with hemodialysis, 40%). 
      The patients were divided into high (n = 93, 50%) and low (n = 92, 50%) FIM-motor 
      cases, and high (n = 157, 85%) and low (n = 28, 15%) FIM-cognitive cases. 
      FIM-motor (high vs. low) and FIM-cognitive (high vs. low) were not significantly 
      associated with limb salvage, freedom from MALE, freedom from readmission, and 
      wound healing. The 1- and 3-year survival rates were significantly lower in low 
      FIM-motor cases (93% vs. 70% at 1 year, 73% vs. 46% at 3 years, P = 0.0011); and 
      in low FIM-cognitive cases (87% vs. 50% at 1 year, 63% vs. 45% at 3 years, P < 
      0.001). The 1- and 3-year AFS rates were significantly lower in low FIM-motor 
      cases (92% vs. 67% at 1 year, 69% vs. 44% at 3 years, P < 0.001); and in low 
      FIM-cognitive cases (85% vs. 49% at 1 year, 59% vs. 44% at 3 years, P < 0.001). 
      In multivariate analysis, independent risk factors for survival were hemodialysis 
      (HR = 2.17; 95% confidence interval (CI), 1.23-3.83; P = .0078), low 
      FIM-cognitive (HR = 3.45; 95% CI, 1.78-6.71; P < 0.001), and ejection fraction 
      (HR = 0.98; 95% CI, 0.95-0.99; P = 0.019). CONCLUSIONS: FIM-motor and 
      FIM-cognitive were predictive factors for long-term survival and AFS of CLTI 
      patients after distal bypass, but had no influence on limb salvage, MALE, 
      readmission, and wound healing. These results suggest that the motor and 
      cognitive status of ADL should be assessed using FIM before distal bypass for 
      patients with CLTI.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Kobayashi, Taira
AU  - Kobayashi T
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, 
      Hatsukaichi-shi, Hiroshima Japan.; Department of Rehabilitation, JA Hiroshima 
      General Hospital, Hatsukaichi-shi, Hiroshima Japan.. Electronic address: 
      ja-t-coba@hotmail.co.jp.
FAU - Kodama, Akio
AU  - Kodama A
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya 
      University School of Medicine, Showa-ku, Nagoya, Aichi Japan.
FAU - Okazaki, Takanobu
AU  - Okazaki T
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, 
      Hatsukaichi-shi, Hiroshima Japan.
FAU - Honma, Tomoaki
AU  - Honma T
AD  - Department of Rehabilitation, JA Hiroshima General Hospital, Hatsukaichi-shi, 
      Hiroshima Japan.
FAU - Yamada, Tetsuya
AU  - Yamada T
AD  - Haruoka-dori clinic, chikusa-ku, Nagoya, Aichi Japan.
FAU - Ishibashi, Hiroyuki
AU  - Ishibashi H
AD  - Vascular Surgery, Aichi Medical University, Nagakute-shi, Aichi Japan.
FAU - Komori, Kimihiro
AU  - Komori K
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya 
      University School of Medicine, Showa-ku, Nagoya, Aichi Japan.
LA  - eng
PT  - Journal Article
DEP - 20211210
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Activities of Daily Living
MH  - Aged
MH  - Amputation, Surgical
MH  - Chronic Disease
MH  - Chronic Limb-Threatening Ischemia
MH  - Functional Status
MH  - Humans
MH  - Ischemia/diagnostic imaging/surgery
MH  - Limb Salvage
MH  - Male
MH  - *Peripheral Arterial Disease/diagnostic imaging/surgery
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
EDAT- 2021/12/14 06:00
MHDA- 2022/06/29 06:00
CRDT- 2021/12/13 20:15
PHST- 2021/09/15 00:00 [received]
PHST- 2021/10/26 00:00 [revised]
PHST- 2021/10/27 00:00 [accepted]
PHST- 2021/12/14 06:00 [pubmed]
PHST- 2022/06/29 06:00 [medline]
PHST- 2021/12/13 20:15 [entrez]
AID - S0890-5096(21)00915-8 [pii]
AID - 10.1016/j.avsg.2021.10.064 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2022 Jul;83:275-283. doi: 10.1016/j.avsg.2021.10.064. Epub 2021 
      Dec 10.