Functional outcome after infrainguinal bypass for limb salvage

Abstract

Purpose: Functional outcome after infrainguinal bypass (IB) has recently been assessed with global health status questionnaires but not by criteria specific to the objectives of IB (i.e., maintenance of independent living and ambulation). Preoperative and postoperative living situation and ambulatory status were evaluated in patients who underwent IB for limb salvage (LS) indications.

Methods: For patients in whom IB was performed for LS from January 1980 to July 1995, living situation (independent or dependent) and ambulatory status were assessed before the onset of the need for LS surgery and 6 months after surgery. The importance of risk factors (age, sex, diabetes, heart disease, hypertension, renal insufficiency or failure, previous leg bypass, indication for surgery, postoperative morbidity, graft patency) was assessed by multivariate analysis.

Results: IB for LS was performed in 513 patients. Before the development of the indication for LS surgery, 92% lived independently and 91% were ambulatory. The operative mortality rate was 2.7%. At 6 months, 86% were alive and the assisted primary graft patency rate was 92%. Ninety-nine percent of survivors who lived independently before developing the need for LS surgery remained independent 6 months after surgery, and 97% of those who were ambulatory before developing the need for LS surgery were ambulatory 6 months after surgery. Only one of 25 survivors (4%) who were not living independently before surgery achieved independent living 6 months after surgery. Twenty-one percent of nonambulatory patients (6 of 29) became ambulatory. Multivariate analysis confirmed the importance of preoperative living situation and ambulatory status in predicting outcome at 6 months (p < 0.0001). Amputation and loss of primary patency were predictive of poor ambulatory status at 6 months (p < 0.0001, p = 0.025, respectively). The overall 5-year survival rate was 48.1%.

Conclusions: Preoperative independence and ambulation best predict postoperative independence and ambulation after IB for LS indications. IB procedures performed for limb salvage have a low operative mortality rate and maintain independent living and ambulation in 99% and 97% of patients, respectively. Poor overall long-term outcome and survival in LS patients results from intercurrent illness and not from IB.