Author + information
- Noor A. Al-Asady,
- Ashwat S. Dhillon,
- Sarah Elsayed,
- David M. Shavelle,
- Vincent L. Rowe and
- Leonardo C. Clavijo
Peripheral surgical bypass for treatment of critical limb ischemia (CLI) is associated with an increased 30-day cardiovascular event rate (8.8% MACE, 1.5% cardiac arrest, 4.7% myocardial infarction, 1.4% stroke and 2.7% death). The purpose of this study is to evaluate 30-day cardiac outcomes in CLI patients after open surgical bypass. We hypothesize that routine transthoracic echo (TTE) screening is an effective initial imaging strategy to risk stratify patients with CLI prior to surgery.
This is a prospective study of 300 patients with CLI. Seventy-six patients underwent below the knee surgical bypass from 2011 to 2016 at LAC+USC Hospital. Baseline demographic, clinical, procedural characteristics, and cardiovascular testing results were recorded. All patients received guideline directed medical therapy. Endpoint was 30-day MACE (death, non-fatal myocardial infarction and non-fatal stroke).
Mean age was 62.5±11 years and 60.5% of patients were male. TTE identified 46 patients (60.5%) with regional wall motion abnormality and 21 patients (27.6%) with left ventricular systolic dysfunction. Fifty-two patients (68.4%) underwent pharmacologic nuclear stress testing based on TTE result and 15 patients had demonstrable myocardial ischemia (19.73%). Fourteen patients (19.3%) had coronary angiography, 11 patients (85%) had significant CAD (defined as lesion ≥ 50%). Coronary revascularization was performed in 8 patients. Overall 30 day MACE was 3.96% and death occurred in one patient, 50% lower than historical controls.
Routine TTE screening is an effective initial imaging strategy to risk stratify patients with CLI before peripheral surgical bypass; its use may decrease post-operatory cardiovascular complications.