JVS-Vascular Insights · Oct 2026
Association between Dementia and Mortality Following Distal Bypass in Patients with Chronic Limb-threatening Ischemia A Retrospective Cohort Study Using a Japanese Nationwide Database
By Horinouchi Y, Suzuki Y, Fujimura N et al.
Objective Distal bypass surgery remains a vital revascularization option for patients with chronic limb-threatening ischemia (CLTI), and one of the key operative indications is a prognosis of more than two years. However, survival of CLTI patients varies depending on comorbidities, and the influence of dementia on survival after distal bypass is not fully elucidated. We hypothesized that preoperative dementia would be independently associated with higher all-cause mortality after distal bypass. Methods This retrospective cohort study used the DeSC database, a nationwide health check-ups and administrative claims database in Japan, and identified 825 patients who underwent distal bypass to tibial or inframalleolar arteries for CLTI between 2014 and 2023; of these, 137 patients were excluded due to missing mortality data, leaving 688 patients for the final analysis. The primary exposure was dementia, defined using ICD-10 codes F00–F03. Kaplan–Meier analysis assessed mortality by dementia status, and multivariable Cox regression analysis evaluated predictors of all-cause mortality including dementia. Results The median age was 77 years, and 72.2% were male. Over a median follow-up of 1.5 years, 284 patients (41.3%) died. Log-rank analysis showed that patients with dementia had significantly worse survival, with one- and three-year survival rates of 54.5% and 18.1%, respectively, compared with 80.0% and 57.0% among patients without dementia (P < 0.001). Multivariable analysis showed that dementia was independently associated with increased mortality (hazard ratio (HR), 1.79; 95% confidence interval (CI), 1.24–2.59, P=0.002), along with higher age (HR, 1.04 per year; 95% CI, 1.03–1.06, P < 0.001), male sex (HR, 1.34; 95% CI, 1.01–1.78, P=0.044), dialysis (HR, 1.77; 95% CI, 1.33–2.35, P < 0.001), and higher Charlson comorbidity index (HR, 1.08 per 1-point increase; 95% CI, 1.02–1.14, P=0.012). Conclusion Dementia was significantly associated with mortality after distal bypass in CLTI patients. Although dementia alone should not be used to determine eligibility for limb-saving revascularization, these findings underscore the importance of incorporating cognitive assessment as part of a comprehensive geriatric evaluation in surgical risk stratification and preoperative planning.