Abstract
Objectives
Tibial revascularization is often performed in the setting of critical limb ischemia
and tissue loss requiring close patient monitoring in the early post-operative period
for worsening gangrene and/or ischemia. Multiple studies have shown loss to follow-up
is an independent risk factor for poor outcomes in several vascular procedures. Therefore,
we evaluated the risk factors relating to loss to follow up against outcomes in patients
undergoing tibial endovascular procedures with the hypothesis that poor post-operative
visit compliance is associated with decreased amputation-free survival rates.
Methods
We performed a single-institution retrospective chart review of patients who underwent
therapeutic endovascular tibial revascularization between 2014–2018. Patient follow-up
and outcomes of death or major amputation (trans-tibial/trans-femoral) were followed
up to 36-months post-operatively. Patients who had undergone previous infra-geniculate interventions
or reached mortality/major amputation within 30-days post-operatively were excluded
from analysis.
Results
We identified 89 patients who met inclusion criteria. The overall rate of attendance
at less than <1 month, 1–6 months, 6–15 months and 15–36 months post-operatively were
60%, 64%, 60 and 40% respectively. 16% of patients had complete loss to follow-up.
Patients without tissue loss (≤ Rutherford 4) were less likely to attend early <1
month and 1–6 month follow-up intervals. Notably, absenteeism from the first immediate
post-operative visit was a significant risk factor for further absenteeism at 1–6
months (51% vs. 26%; P = 0.01) and at greater than 6-month follow-up (48% vs. 31%; P = 0.05). Compared to the cohort of all patients, failure to follow-up within 1 month
was associated with a decrease in attendance from 64% to 26% at 1–6 months and 63–31%
at more than 6 months. Missing the first post-operative visit was also associated
with decreased amputation-free survival (P = 0.04).
Conclusions
Absenteeism from the first post-operative visit is associated with worse amputation-free
survival and a significant risk factor for further absenteeism from post-operative
care. Given these results, ensuring close immediate post-operative follow up is essential
to improving outcomes in patients undergoing tibial revascularization.
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Article Info
Publication History
Published online: December 22, 2021
Accepted:
November 11,
2021
Received in revised form:
October 18,
2021
Received:
July 10,
2021
Footnotes
Work presented virtually at the Vascular and Endovascular Surgery Society 2021 Annual meeting.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
