PMID- 36442707
OWN - NLM
STAT- MEDLINE
DCOM- 20230307
LR  - 20230307
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 90
DP  - 2023 Mar
TI  - Effectiveness of the Vascular Quality Initiative Chronic Limb-Threatening 
      Ischemia Mortality Prediction Model in Patents with Distal Bypass.
PG  - 188-196
LID - S0890-5096(22)00744-0 [pii]
LID - 10.1016/j.avsg.2022.10.021 [doi]
AB  - BACKGROUND: The purpose of this study is to evaluate the effectiveness of 
      mortality prediction using the Vascular Quality Initiative (VQI) chronic 
      limb-threatening ischemia (CLTI) model in patients with distal bypass. METHODS: 
      Patients who underwent distal bypass for CLTI from 2009 to 2020 at a single 
      center were retrospectively reviewed. Distal bypass was defined as any bypass 
      with a distal anastomosis to the posterior tibial, anterior tibial, dorsalis 
      pedis, plantar, or peroneal artery. Baseline characteristics, operative details, 
      hospital outcomes, and medium-term outcomes were compared among patients with a 
      low-, medium-, and high-risk of mortality based on a VQI CLTI calculation. The 
      primary endpoints were survival and limb salvage. RESULTS: A total of 287 distal 
      bypasses were performed in 230 patients (153 males; median age, 74 years; 
      diabetes mellitus, 70%; end-stage renal disease [ESRD] with hemodialysis, 38%). 
      These patients were stratified into 153 (66%) low-, 35 (15%) medium-, and 42 
      (18%) high-risk cases based on the VQI CLTI model. There were two hospital deaths 
      (1%) within 30 days. During a mean follow-up period of 33 +/- 29 months, 105 
      patients died and 26 limbs (9%) required major amputation. The 2-year survival 
      rate of 81% in the low-risk group was significantly higher than those of 41% in 
      the medium-risk group and 46% in the high-risk group (both P < 0.001). The 2-year 
      survival rates did not differ significantly between the medium- and high-risk 
      groups (P = 0.81). The 2-year limb salvage rate of 93% in the low-risk group was 
      significantly higher than those of 81% in the medium-risk (P = 0.023) and those 
      of 87% in the high-risk (P = 0.039) groups. There were no significant differences 
      in graft patency and wound healing among the three groups. CONCLUSIONS: These 
      results suggest that distal bypass is optimal treatment for patients with a low 
      VQI-predicted risk of mortality. However, the lower limb salvage and higher 
      mortality rates at 2 years suggest that the decision-making for VQI medium- and 
      high-risk patients may be carefully considered.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Kobayashi, Taira
AU  - Kobayashi T
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, 
      Japan. Electronic address: ja-t-coba@hotmail.co.jp.
FAU - Hamamoto, Masaki
AU  - Hamamoto M
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, 
      Japan.
FAU - Okazaki, Takanobu
AU  - Okazaki T
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, 
      Japan.
FAU - Tomota, Mayu
AU  - Tomota M
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, 
      Japan.
FAU - Fujiwara, Takashi
AU  - Fujiwara T
AD  - Department of Cardiology, JA Hiroshima General Hospital, Hiroshima, Japan.
FAU - Hasegawa, Misa
AU  - Hasegawa M
AD  - Department of Reconstructive and Plastic Surgery, JA Hiroshima General Hospital, 
      Hiroshima, Japan.
FAU - Takahashi, Shinya
AU  - Takahashi S
AD  - Department of Cardiovascular Surgery, Hiroshima University, Hiroshima, Japan.
LA  - eng
PT  - Journal Article
DEP - 20221125
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Male
MH  - Humans
MH  - Aged
MH  - *Chronic Limb-Threatening Ischemia
MH  - Treatment Outcome
MH  - Retrospective Studies
MH  - Ischemia
MH  - Vascular Patency
MH  - Risk Factors
MH  - Limb Salvage/methods
MH  - *Peripheral Arterial Disease
EDAT- 2022/11/29 06:00
MHDA- 2023/03/08 06:00
CRDT- 2022/11/28 19:34
PHST- 2022/07/13 00:00 [received]
PHST- 2022/10/12 00:00 [revised]
PHST- 2022/10/27 00:00 [accepted]
PHST- 2022/11/29 06:00 [pubmed]
PHST- 2023/03/08 06:00 [medline]
PHST- 2022/11/28 19:34 [entrez]
AID - S0890-5096(22)00744-0 [pii]
AID - 10.1016/j.avsg.2022.10.021 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2023 Mar;90:188-196. doi: 10.1016/j.avsg.2022.10.021. Epub 2022 
      Nov 25.