Predictors of Taylor et al for Failure to Achieve Successful Surgical Bypass of Lower Extremity Ischemic Disease

 

Patient selection: ischemic vascular disease in the lower extremity with an intact limb

 

Criteria for successful outcome - all of the following:

(1) sufficient graft patency for wound healing

(2) limb salvage for at least 1year

(3) ambulatory for at least 1 year

(4) survival for 6 months (if criteria 2 and 3 are met, then survival must have been to 12 months)

 

Factors affecting outcome:

(1) ambulatory status

(2) location of atherosclerotic disease

(3) end-stage renal disease (ESRD)

(4) gangrene

(5) hyperlipidemia

 

Parameter	Finding	Odds Ratio for Failure
ambulatory status	normal	1
	impaired	6.4
location of atherosclerotic disease	aortoiliac only	1
	infrainguinal disease	3.9
end-stage renal disease	absent	1
	present	2.5
gangrene	absent	1
	present	2.4
hyperlipidemia	absent	1
	present	0.56

 

where:

• Impaired ambulatory status included ambulatory in home only and nonambulatory but able to use legs for transfer. According to page 833 this does not include bedridden, but no one in the study was in this group.

• Location of atherosclerotic disease was aortoiliac vs infrainguinal.

 

cumulative odds of failing to achieve a successful surgical outcome =

= PRODUCT(odds ratios for all of the 5 parameters)

 

Interpretation:

• minimum cumulative odds for failure is when hyperlipidemia alone is present (0.56 against or 2:1 for success).

• maximum cumulative odds" 150

• The cumulative odds shown in Table 4 (page 837) are based on the products for the individual factors.