A Multicenter Predictive Score for Amputation-Free Survival for Patients Operated on with an Heparin-Bonded ePTFE Graft for Critical Limb Ischemia

• Published in: World journal of surgery 2017, Vol.41 (1), p.306-313
• Main Authors: Dorigo, Walter, Piffaretti, Gabriele, Pulli, Raffaele, Castelli, Patrizio, Pratesi, Carlo
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Age Factors; Aged; Amputation; Anticoagulants - administration & dosage; Blood Vessel Prosthesis; Cardiac Surgery; Coated Materials, Biocompatible; Coronary Artery Disease - complications; Critical Limb Ischemia; Female; General Surgery; Graft Patency; Heparin - administration & dosage; Humans; Ischemia - surgery; Kidney Failure, Chronic - complications; Limb Salvage; Lower Extremity - blood supply; Male; Medicine; Medicine & Public Health; Multivariate Analysis; Original Scientific Report; Polytetrafluoroethylene; Primary Patency; Prosthetic Graft; Retrospective Studies; Risk Assessment; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-016-3674-z

Aim of the study To 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). Methods Over 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. Results Overall, 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