Predictors of long-term patient survival after in situ vein leg bypass

Purpose: The objective was to determine the long-term survival rates of patients who undergo distal arterial bypass surgery and to identify the preoperative factors that are predictive of survival. Methods: Three hundred fifty-eight consecutive in situ distal leg bypass procedures were performed between July 1986 and December 1995. The relationship between 13 preoperative variables and late survival were determined using both univariate (Kaplan-Meier) and multivariate (Cox regression) statistical techniques. Results: The cumulative survival rates at 1, 3, 5, and 7 years were 86.6% +/- 2.0%, 63.2% +/- 3.0%, 46.9% +/- 3.4%, and 35.3% +/- 3.8%, respectively. Using Cox regression, four significant variables were found to be associated with lower late survival rates: male gender, diabetes, chronic renal insufficiency (patients with creatinine levels greater than or equal to 1.7 mg/dl or 150 SI units), and a history of cerebrovascular disease (p < 0.001 for model). When none of these four variables were present, the predicted 5-year survival rate was 71%, whereas the survival rate was reduced to 43% to 60% when one was present, 23% to 42% when two were present, 8% to 22% when three were present, and 2% when all four were present. Conclusions: This study defines the long-term survival rates in a cohort of patients after undergoing distal bypass surgery and demonstrates that certain preoperative factors are predictive of late survival. Knowledge of these factors may be useful to assist in individual operative decisions between aggressive attempts at distal revascularization versus primary amputation.