Outcomes of lower extremity revascularization among the XXXX .

@entity1 @entity63 @entity613 @entity158 @entity1030 @entity453 @entity204 @entity734
OBJECTIVE: Optimal @entity1 selection for lower extremity revascularization remains a clinical challenge among the @entity734 ( @entity734 ). The purpose of this study was to examine contemporary real world open and endovascular outcomes of @entity734 @entity1 to better facilitate @entity1 selection for intervention. METHODS: A regional multicenter registry was queried between 2003 and 2013 for @entity734 @entity1 (N  = 689) undergoing open surgical bypass (n  = 295) or endovascular intervention (n  = 394) for lower extremity revascularization. @entity1 demographics and comorbidities were recorded. The primary outcome was overall survival. Secondary outcomes included graft patency, freedom from major adverse limb events, and amputation-free survival (AFS). Multivariate analysis was performed to identify independent risk factors for @entity204 and amputation. RESULTS: Among the 689 @entity734 @entity1 undergoing lower extremity revascularization, 66% were male, and 83% were white. Ninety percent of revascularizations were performed for @entity63 and 8% for @entity613 . Overall survival at 1, 2, and 5  years survival remained low at 60%, 43%, and 21%, respectively. Overall 1- and 2-year AFS was 40% and 17%. Mortality accounted for the primary mode of failure for both open bypass (78%) and endovascular interventions (80%) at two years. Survival, AFS, and freedom from major adverse limb event outcomes did not differ significantly between revascularization techniques. At 2  years, endovascular patency was higher than open bypass (76% vs 26%; 95% confidence interval [CI], 0.28-0.71; P  = .02). Multivariate analysis identified age >= 80  years (hazard ratio [HR], 1.9; 95% CI,  1.4-2.5; P  < .01), indication of @entity158 or tissue loss (HR, 1.8; 95% CI, 1.3-2.6; P  < .01), preoperative wheelchair/bedridden status (HR, 1.5; 95% CI, 1.1-2.1; P  < .01), @entity453 (HR, 1.5; 95% CI, 1.2-1.9; P  < .01), and @entity1030 (HR, 1.4; 95% CI, 1.1-1.8; P  = .01) as independent predictors of @entity204 . The presence of three or more risk factors resulted in predicted 1-year mortality of 64%. CONCLUSIONS: Overall survival and AFS among @entity734 @entity1 remains poor, irrespective of revascularization strategy. Mortality remains the primary driver for these findings and justifies a prudent approach to @entity1 selection. Focus for improved results should emphasize predictors of survival to better identify those most likely to benefit from revascularization.
