The purpose of this study was to evaluate the effect of preoperative motor and cognitive
activities of daily living (ADL) on long-term outcomes of patients with chronic limb-threatening
ischemia (CLTI) after distal bypass.
A retrospective review was performed for patients who underwent distal bypass for
CLTI from 2013 to 2019 at multiple centers in Japan. Comparisons were made among patients
with high and low motor and cognitive ADL based on the functional independence measure
(FIM). The primary endpoint was limb salvage and the secondary endpoints were survival,
amputation free survival (AFS), major adverse limb events (MALE), readmission, and
A total of 226 distal bypasses were performed in 185 patients (169 males; median age,
76 years; diabetes mellitus, 70%; end-stage renal disease with hemodialysis, 40%).
The patients were divided into high (n = 93, 50%) and low (n = 92, 50%) FIM-motor cases, and high (n = 157, 85%) and low (n = 28, 15%) FIM-cognitive cases. FIM-motor (high vs. low) and FIM-cognitive (high
vs. low) were not significantly associated with limb salvage, freedom from MALE, freedom
from readmission, and wound healing. The 1- and 3-year survival rates were significantly
lower in low FIM-motor cases (93% vs. 70% at 1 year, 73% vs. 46% at 3 years, P = 0.0011); and in low FIM-cognitive cases (87% vs. 50% at 1 year, 63% vs. 45% at
3 years, P < 0.001). The 1- and 3-year AFS rates were significantly lower in low FIM-motor cases
(92% vs. 67% at 1 year, 69% vs. 44% at 3 years, P < 0.001); and in low FIM-cognitive cases (85% vs. 49% at 1 year, 59% vs. 44% at 3
years, P < 0.001). In multivariate analysis, independent risk factors for survival were hemodialysis
(HR = 2.17; 95% confidence interval (CI), 1.23-3.83; P = .0078), low FIM-cognitive (HR = 3.45; 95% CI, 1.78-6.71; P < 0.001), and ejection fraction (HR = 0.98; 95% CI, 0.95-0.99; P = 0.019).
FIM-motor and FIM-cognitive were predictive factors for long-term survival and AFS
of CLTI patients after distal bypass, but had no influence on limb salvage, MALE,
readmission, and wound healing. These results suggest that the motor and cognitive
status of ADL should be assessed using FIM before distal bypass for patients with