Background
In cases of intermittent claudication (IC) where traditionally noninvasive management
yields unsatisfactory results, revascularization strategy in IC patients is generally
decided based on anatomical considerations and the availability of a saphenous vein
graft. Life expectancy should also be considered. This study aimed to investigate
the relationship between the 11-item modified frailty index (mFI-11) and the overall
survival (OS) in patients with IC who underwent vascular bypass surgery to facilitate
revascularization strategy selection.
Methods
We reviewed the records of 144 consecutive patients (153 lower limbs) who underwent
infrainguinal bypass for IC between 2011 and 2020. Patients were divided into 2 groups
based on their mFI-11 score: high frailty (H), mFI score >0.3; and low frailty (L),
mFI score ≤0.3. The OS was compared among the 2 groups. Rates of graft patency and
freedom from major adverse limb event (ffMALE) were also determined and compared.
Results
Five-year OS in the L and H groups was 92% and 55% (P < 0.001). Multivariate analysis showed that mFI, age, and end-stage renal disease
were independent predictors of OS. Five-year rates of primary and secondary patency
and ffMALE for vein grafts were 81%, 91%, and 94%, respectively; those for prosthetic
grafts were 65%, 80%, and 84%, respectively; the differences were not significant.
Conclusions
The mFI-11 was a helpful tool in predicting OS for patients with IC who underwent
vascular bypass surgery. Those with H should not undergo open revascularization; however,
for IC patients who have either not responded to a regimen of exercise and medication,
or have specifically requested a more aggressive approach, obtaining a good score
in frailty assessment is useful in determining whether or not bypass surgery would
be a viable option.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Annals of Vascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American college of cardiology/American heart association task force on clinical practice guidelines.Circulation. 2017; 135: e726-e779
- Editor's choice - 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European society for vascular surgery (ESVS).Eur J Vasc Endovasc Surg. 2018; 55: 305-368
- IN.PACT global study investigators. Drug-coated balloon treatment for femoropopliteal artery disease.Circ Cardiovasc Interv. 2018; 11: e005654
- Theodosios bisdas 2-year outcomes of the Eluvia drug-eluting stent for the treatment of complex femoropopliteal lesions.JACC Cardiovasc Interv. 2021; 14: 692-701
- Long-term survival and fate of the leg in de novo intermittent claudication.Eur Heart J Qual Care Clin Outcomes. 2017;1; 3: 208-215
- The assessment of frailty in older adults.Clin Geriatr Med. 2010; 26: 275-286
- Validation of a modified Frailty Index to predict mortality in vascular surgery patients.J Vasc Surg. 2016; 63: 1595-1601
- Influence of frailty on treatment outcomes after revascularization in patients with critical limb ischemia.J Vasc Surg. 2017; 66: 1758-1764
- Impact of frailty on clinical outcomes in patients with critical limb ischemia.Circ Cardiovasc Interv. 2018; 11: e006778
- The 11-item modified frailty index as a tool to predict unplanned events in traumatic brain injury.Am Surg. 2020; 86: 1596-1601
- Gender and frailty predict poor outcomes in infrainguinal vascular surgery.J Surg Res. 2016; 201: 156-165
- Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a National database.J Surg Res. 2013; 183: 104-110
- Raison d'etre of tibial artery bypass for intermittent claudication in the era of endovascular therapy.Circ J. 2016;25; 80: 1460-1469
- Barthel index and outcome of open bypass for critical limb ischemia.Circ J. 2017;25; 82: 251-257
- Preoperative nutritional status as an independent predictor of the long-term outcome in patients undergoing open bypass for critical limb ischemia.Ann Vasc Surg. 2020; 64: 202-212
- Anemia increases mortality after open or endovascular treatment in patients with critical limb ischemia: a retrospective analysis.Eur J Vasc Endovasc Surg. 2016; 51: 543-549
- Impact of the geriatric nutritional risk index on the long-term outcomes of patients undergoing open bypass for intermittent claudication.Circ J. 2019; 83: 1349-1355
- Completeness of follow-up determines validity of study findings: results of a prospective repeated measures cohort study.PLoS One. 2015; 10: e0140817
- A modified frailty index to assess morbidity and mortality after lobectomy.J Surg Res. 2013; 183: 40-46
- Frailty as a predictor of morbidity and mortality in inpatient head and neck surgery.JAMA Otolaryngol Head Neck Surg. 2013; 139: 783-e9789
- Scoping review of frailty in vascular surgery.J Vasc Surg. 2019; 69: 1989-1998
- Frailty assessment in older adults undergoing interventions for peripheral arterial disease.J Vasc Surg. 2019; 70: 1594-1602
- Frailty is associated with an increased risk of major adverse cardiac events in patients with stable claudication.Ann Vasc Surg. 2018; 50: 38-45
- Sarcopenia is a prognostic factor for overall survival in patients with critical limb ischemia.J Vasc Surg. 2015; 61: 945-950
- Inter-society consensus for the management of peripheral arterial disease (TASC II).J Vasc Surg. 2007; 45: S5-S67
- Classification and clinical impact of restenosis after femoropopliteal stenting.J Am Coll Cardiol. 2012; 59: 16-23
Article info
Publication history
Published online: December 09, 2022
Accepted:
October 25,
2022
Received:
March 21,
2022
Footnotes
Funding sources: None.
Disclosures: None.
Author contributions: SM contributed to the conception and design. SM and TM contributed to analysis and interpretation. MI, AG, SY and RY contributed to data collection. SM and TM contributed to writing the article. SM, AG, SY, MI, and TM contributed to critical revision of the article. SM contributed to final approval of the article. SM contributed to statistical analysis. SM contributed to overall responsibility.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
