Mortality following operations for lower extremity peripheral arterial disease

Tracie C Collins^1,2, David Nelson³, Jasjit S Ahluwalia^1,2

¹Department of Medicine, Division of General Internal Medicine, University of Minnesota Minneapolis, MN, USA; ²Center for Health Equity, University of Minnesota Medical School, Minneapolis, MN, USA; ³Minneapolis VA Medical Center, Center for Chronic Disease Outcomes Research, University of Minnesota, Minneapolis, MN, USA

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