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ORIGINAL ARTICLE
Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 24-29

Race and outcomes of lower extremity revascularization for critical limb ischemia


1 Department of Surgery, Harlem Hospital Center, New York, NY, USA
2 Johns Hopkins Bayview, Vascular and Endovascular Research Center, Baltimore, MD, USA
3 Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA
4 Department of Surgery, University of South Florida, Tampa, FL, USA

Correspondence Address:
Mahmoud B Malas
Professor of Surgery, Johns Hopkins School of Medicine, Director of the Center for Research Excellence and Surgical Trials (CREST), The Johns Hopkins Hospital, Chief of Endovascular Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/VIT.VIT_8_18

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INTRODUCTION: Studies have shown poor outcomes following infra-inguinal bypass in African-American patients compared with Caucasians. The aim of this study was to investigate the racial disparity in a cohort of patients who underwent infra-inguinal bypass surgery at our institute. METHODS: We retrospectively reviewed data of all patients who underwent infra-inguinal bypass performed with autogenous vein grafts for symptomatic peripheral artery disease from 2007–2014 at a single tertiary care institution. Univariate (Chi-square test and Student's t-test) and multivariable analyses (logistic and Cox regression) were used to evaluate the association between race and the outcomes of mortality, primary and primary-assisted patency, and limb loss following infra-inguinal bypass. RESULTS: The study included 412 autogenous bypass grafts, of which 312 (76%) were performed in Caucasians and 100 (24%) in African-Americans. African-American patients had significantly higher comorbidities including diabetes (74% vs. 57%, P = 0.002) and chronic kidney disease on dialysis (22% vs. 10%, P = 0.002) as compared with Caucasians. The majority of patients in both groups underwent bypass for critical limb ischemia (88% vs. 87%, P = 0.71). Mean follow-up time was 1.8 ± 1.8 years. The rates of major amputation were not significantly different between two groups (17% vs. 10%, P = 0.07). Moreover, no significant differences in primary and primary assisted were seen between African-Americans and Caucasians (hazard ratio [HR] [95% confidence interval [CI]: 0.90 [0.56–1.44], P = 0.66 and 1.21 [0.72–2.03], P = 0.46), respectively. Hyperlipidemia was shown to be significantly associated with primary-assisted patency, while diabetes was a significant risk factor for limb loss [HR (95% CI): 2.73 (1.26–5.93), P = 0.01). CONCLUSION: In this study, there were no significant differences in bypass patency and limb salvage between African-Americans and Caucasians following infra-inguinal bypass over 5-year follow-up. These findings suggest that the outcomes of infra-inguinal bypass can be optimized in African-American patients with the use of autogenous vein conduits and comprehensive medical management including the control of diabetes and hyperlipidemia.


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