Validation of the Guy’s scoring system in patient selection for femoro-distal bypass grafting to a single calf or pedal artery

Abstract

Objectives First external validation of a preoperative scoring system (Guy’s) in patient selection for femoro-distal bypass grafting to single calf or pedal artery in critical limb ischemia (Fontaine III & IV/Rutherford grade IV, V & VI). Material and methods A prospective study of 76 ( n = 76) consecutive femoro-crural/pedal bypass grafts on 72 individuals ( n = 72) from 2008 to 2011 with 36 months mean follow-up was performed. All cases were scored against a previously designed and published scoring system (ranging from 0 to 10) based on: inflow, outflow, graft material, flow type, patent pedal vessels and diabetes mellitus. Results Preoperative score of 0–4 ( n = 37) demonstrated the primary patency of 27% at 10.3 months. This value for intermediate group 5–7 ( n = 34) was 70.6% at 18.9 months. The high-score group 8–10 ( n = 4) showed the longest primary patency (80%) at 27.3 months. Kaplan–Meier survival analysis exhibited a consistent and significant difference in primary assisted, secondary patency and overall limb/foot salvage amongst all individual scoring groups ( p < 0.001). Conclusion This study validates and complements the Guy’s scoring system and provides a platform for the identification of critical limb ischemia patients in whom the result of femoro-crural/distal bypass grafting is so poor that primary amputation may be both clinically and economically more justified.