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Background: Frailty in vascular surgery patients is increasingly recognized as a marker of poor outcome. This provides particular challenges for patients with lower limb peripheral arterial disease who require surgical revascularization. This study aimed to assess the impact of frailty on short- and long-term outcome in this specific patient group using a specialty specific frailty score., Methods: Patients undergoing open surgical revascularization for chronic limb ischemia (January 2015-December 2016) were assessed. Demographics, mode of admission, diagnosis, and site of surgery were recorded alongside a variety of frailty-specific characteristics. We calculated the previously validated Addenbrookes Vascular Frailty Score (AVFS) and Long AVFS (LAVFS). Primary outcome was 3-year mortality., Results: Two hundred and sixty-one patients (75% men, median age 69 years) were studied. The median length of stay was 6 days with a 3-year mortality of 23%. The predictive power of vascular frailty scores showed that for 3-year mortality, area under the receiver operator curve values (AUROC) were specific for both the AVFS score (AUROC: 0.724, 95% CI: 0.654-0.794) and LAVFS Score (AUROC: 0.741, 95%CI: 0.670-0.813). Furthermore, the cumulative AVFS and LAVFS scores both predicted mortality over the follow-up period (P=0.0001) with increased mortality among patients with higher scores., Conclusions: Incremental worsening of frailty, determined using a specialty specific frailty score, predicts mortality risk in patients undergoing lower limb surgical revascularization.

Aim: This study was designed to determine how aware patients with peripheral arterial disease (PAD) were with regard to the risk factors (RF) associated with atherosclerosis., Methods: Seventy patients (49 men; median age 72 years, range 42-89 years) with PAD admitted as inpatients to the department of vascular surgery over a three-month period were asked to complete a single-paged questionnaire. Data were also obtained from the hospital notes with regard to gender, age, actual RFs that each patient suffered from, admission route (elective or acute), drug history and diagnosis., Results: Diabetes mellitus (DM): 16 patients (23%) had DM, 15 (94%) of whom were aware of their condition, but only 5 (31%) believed DM to be a vascular RF. Smoking: 53 patients (76%) were either current smokers or had recently stopped smoking, only 31 (58%) of which knew smoking to be a cardiovascular RF. Hypercholestero-laemia: 41patients (59%) had been diagnosed with hypercholesterolaemia, 29 (71%) of which actually knew their cholesterol level was elevated, but only 10 (25%) believed it to be a RF for vascular disease. Hypertension: 40 patients (57%) were known hypertensives, 75% of which knew that they had hypertension but only 10% knew that it was a RF for vascular disease., Conclusion: RF awareness amongst patients with PAD is suboptimal. Intensive efforts need to be undertaken to educate this patient cohort in order to improve consciousness for best medical therapy.