ArticleWorld journal of surgery2017
A Multicenter Predictive Score for Amputation-Free Survival for Patients Operated on with an Heparin-Bonded ePTFE Graft for Critical Limb Ischemia.
Article in World journal of surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aim of the studyTo retrospectively create a predictive score for estimating amputation-free survival (AFS) in patients with critical limb ischemia (CLI) operated on with the use of a heparin-bonded expanded polytetrafluoroethylene (ePTFE) bypass graft (Hb-ePTFE).
methodsOver a 13-year period, ending in March 2015, a Hb-ePTFE graft was implanted in 683 patients undergoing below-knee revascularization for CLI in seven Italian vascular hospitals. Data concerning these interventions were retrospectively collected in a multicenter registry with a dedicated database. Univariate and multivariable analyses with Kaplan-Meier estimates were used to identify potential significant predictors of AFS at 5 years, and then a predictive risk score was constructed. A qualitative assessment of the Kaplan-Meier survival estimates for each integer score was performed, and subgroups of risk were stratified on the basis of the primary end point.
resultsOverall, estimated 5-year AFS rate was 48.3 % (SE 0.024). At multivariate analysis, older age, coronary artery disease, end-stage renal disease, tissue loss and poor runoff score were predictors of AFS. The integer score ranged from 0 to 11; Kaplan-Meier analysis for AFS in each score group identified three subgroups with significant differences at 5 years: low-risk subgroup (scores from 0 to 2, 67.7 %), medium-risk subgroup (scores 3 and 4, 49.2 %, p < 0.001 in comparison with low-risk subgroup) and high-risk subgroup (scores from 5 to 11, 25.2 %, p < 0.001 in comparison with either low-risk subgroup or medium-risk subgroup).
conclusionsA category of low-risk patients with CLI treated with the indexed graft does exist, thus suggesting a primary role for Hb-ePTFE in such patients. A prospective validation of such a score is necessary.
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