DO ROUTINELY REGISTERED PREOPERATIVE DATA PROVIDE PROGNOSTIC INFORMATION ON THE SHORT-TERM OUTCOME OF DISTAL BYPASS-SURGERY

One hundred and thirty and patients were operated on with unilateral d istal bypass procedures for critical ischemia. Fifty-one patients (39% ) ended up with graft occlusion or required major amputation within si x months after reconstruction. Two-year graft patency was 38%. These r ather disappointing results may be partly ascribed to inadequate preop erative selection of patients. Logistic regression model was used to a ssess whether the independent variables age, gender, diabetes mellitus , smoking, ankle-brachial pressure index (ABI), type of graft, coronar y heart disease (CHD), previous vascular operation and sire of distal anastomosis were associated with the outcome amputation and graft occl usion six months after reconstruction. CHD, type of graft, ABI and the location of distal anastomosis were significantly associated with out come. The odds for amputation or occlusion was 2.4 limes higher in the CHD group, 4 times higher if the anastomosis was located to the peron eal artery and 2.6 times higher for synthetic grafts. The logistic reg ression model was statistical significant (p = 0.03). However, the mod el did not aid sufficiently in the prediction of outcome, since one th ird was erroneously classified as success or failure. Cox's proportion al hazard regression was employed to estimate the influence of the ind ependent variables on graft patency. Favorable patency was found for t hose with distal anastomosis located to the tibial arteries, the non-C HD group and for higher ABI values. There was a trend towards signific ance for better patency in the autogenous vein group (P = 0.06). Altho ugh combinations of risk factors usable for preoperative prediction of the likelihood of graft failure, appropriate selection models of pati ents suitable for distal bypass operation have to be improved, to mini mize the number of failed procedures.