Impact of Dementia on the Outcome of Surgical Revascularization for Chronic Limb-Threatening Ischemia.

Abstract

Objectives: Dementia and chronic limb-threatening ischemia (CLTI) are independent risk factors for a poor life prognosis. We investigated the long-term results of surgical revascularization for CLTI complicated by dementia. Methods: The clinical records of 174 consecutive patients with CLTI and 205 revascularized limbs were prospectively collected from a database. According to the criteria for dementia, the patients were divided into a low-grade dementia group (L group, n = 152) and a high-grade dementia group (H group, n = 22), and the long-term results after surgery were retrospectively analyzed. Results: The 2-year amputation-free survival (AFS) after surgery was significantly lower in the H group than in the L group (L group, 82.3%; H group, 39.3%; p <0.001). However, no marked differences were observed between the dementia groups regarding the freedom from major adverse limb event (MALE) (L group, 86.6%; H group, 83.1%; p = 0.103), freedom from major adverse cardiovascular event (MACE) (L group, 75.6%; H group, 71.3%; p = 0.685), and limb salvage (L group, 75.6%; H, group 71.3%; p = 0.685) after surgery. Conclusions: Dementia may be a predictor of a poor prognosis after surgery for CLTI. However, surgical revascularization may lead to limb salvage without serious postoperative complications. Therefore, surgical revascularization may be a useful treatment option if the patient or family requires such treatment.