End-stage renal disease—Is infrainguinal limb revascularization justified?

Harrington, Elizabeth B.; Harrington, Michael; Schanzer, Harry; Haimov, M

doi:10.1067/mva.1990.24603

Cited by 70 publications

(28 citation statements)

References 7 publications

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“…Infections usually account for most of the remaining mortality observed postoperatively. Harrington et al [26], in their series of 39 ESRD patients with surgical revascularization, reported up to 43% of death related to sepsis. In our study, patients undergoing bypass procedures were at increased risk of infection related mortality but so were also older patients, patients with a prior history of transplantation, and patients with a low hematocrit.…”

Section: Discussionmentioning

confidence: 98%

Predictors of amputation and survival following lower extremity revascularization in hemodialysis patients

Jaar¹,

Astor²,

Berns³

et al. 2004

Kidney International

105

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Risk of amputation following revascularization procedures was positively associated with type of procedure, black race, uninsured/Medicaid, and diabetes status. Risk of death was also higher following bypass. While this might reflect underlying severity of disease, patient education, screening, and optimal care of lower extremities should be emphasized to detect PVD at an early stage of the disease process.

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Section: Discussionmentioning

confidence: 98%

Predictors of amputation and survival following lower extremity revascularization in hemodialysis patients

Jaar¹,

Astor²,

Berns³

et al. 2004

Kidney International

105

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“…amputation or revascularization) is more prevalent among patients with renal insufficiency than in those with normal renal function (1)(2)(3). High serum creatinine is associated with poor long-term outcomes after lower extremity revascularization (4) and numerous small retrospective surgical series of revascularization in patients with advanced renal insufficiency have now shown that these patients are at increased risk for short-and long-term post-operative mortality and graft failure compared to patients with normal renal function (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

mentioning

confidence: 99%

Impact of Renal Insufficiency on Short-Term Morbidity and Mortality after Lower Extremity Revascularization

O’Hare¹,

Feinglass

Sidawy³

et al. 2003

Journal of the American Society of Nephrology

108

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Abstract. Few data are available on the impact of renal insufficiency on short-term operative outcomes after lower extremity surgical revascularization. We used prospectively collected data from the Department of Veterans Affairs' National Surgical Quality Improvement Program (NSQIP) to explore the association with renal dysfunction of adverse outcomes occurring within 30 d of lower extremity surgical revascularization in a cohort of all patients undergoing at least one lower extremity surgical revascularization from 1/1/94 to 9/30/01 (n ϭ 18,217). Even moderate renal insufficiency (estimated GFR 30-59cc/min/1.73m2 ) was associated with an increased incidence of postoperative death (adjusted odds ratio (OR) 1.44, 95% confidence interval (CI), 1.17 to 1.77, P ϭ 0.001), cardiac arrest (OR 1.43, CI 1.09 to 1.88, P ϭ 0.011), myocardial infarction (OR 1.68, 1.39 to 2.16, P Ͻ 0.001), unplanned intubation (OR 1.69, CI 1.39 to 2.07, P Ͻ 0.001) and prolonged intubation (OR 1.57, CI 1.28 to 1.94, P Ͻ 0.001) within 30 d of lower extremity revascularization. However, the incidence of wound infection and graft failure requiring return to the operating room did not appear to be substantially higher in this group. Our data also show that patients with renal insufficiency undergoing revascularization were more likely to require distal procedures and to present with limb-threatening infection compared to those with normal renal function. Efforts to improve pre-and post-operative care in patients with renal insufficiency undergoing lower extremity revascularization should take into account the increased incidence of postoperative death and cardiopulmonary complications in this group in addition to more traditional concerns about operative site complications. Further studies are needed to explore reasons for the higher rate of limb-threatening infection in patients with renal insufficiency undergoing revascularization.Peripheral vascular disease requiring operative intervention (i.e. amputation or revascularization) is more prevalent among patients with renal insufficiency than in those with normal renal function (1-3). High serum creatinine is associated with poor long-term outcomes after lower extremity revascularization (4) and numerous small retrospective surgical series of revascularization in patients with advanced renal insufficiency have now shown that these patients are at increased risk for short-and long-term post-operative mortality and graft failure compared to patients with normal renal function (5-23).However, few data are available to patients, families and health care providers regarding the association of specific adverse outcomes for patients with renal insufficiency after lower extremity revascularization surgery. Large variations in patient characteristics (such as inclusion of patients not yet requiring dialysis or renal transplant patients), indications for surgery and nature of surgery performed exist between retrospective surgical series. Therefore, it has proven difficult to

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“…Some authors proposed using similar criteria for limb revascularization, whether or not the patient had ESRD. 4 This was applied in our study, and the difference in the frequency of revascularization (31% vs 79%, p = 0.0036) was due to the absence of outflow vessels suitable for revascularization in the ESRD group, and the high prevalence of infrapopliteal arterial involvement as judged by arteriography. In this series, endovascular techniques were not performed owing to extensive calcifications and long occlusions, 2 poor predictive factors for the technical success of transluminal angioplasty or subintimal revascularization.…”

Section: Discussionmentioning

confidence: 99%

Foot Gangrene in Patients with End-Stage Renal Disease: A Case Control Study

et al. 2006

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The prevalence of peripheral arterial disease (PAD) in patients with end-stage renal disease (ESRD) is high, with an annual risk of amputation estimated at 13%, and indications for limb revascularization in patients combining ESRD with stage IV PAD (foot gangrene) are still controversial. This case-controlled study compared survival, limb salvage, and quality of life in a group of patients hospitalized for foot gangrene according to their renal status (ESRD versus no renal insufficiency). All patients with ESRD hospitalized for foot gangrene (n = 16) from 1996 to 2002 were compared with a control group with normal creatininemia (n = 24) hospitalized for foot gangrene due to peripheral atherosclerotic arterial disease. The 2 groups were matched for age, sex ratio, and number with diabetes mellitus. After a mean follow-up of 467 +/-410 days, patients with ESRD had a more severe prognosis as regards mortality (68.7% vs 12.5%, p = 0.0005) and major amputation (31% versus 8%, p = 0.09). The ESRD group was characterized by more frequent extensive arterial calcifications (16/16 vs 13/24, p = 0.002), owing to a higher level of the calcium phosphorus product (3.54 +/-1.2 vs 2.4 +/-0.6, p = 0.0023), and by impaired microcirculatory perfusion, as indicated by a lower oxygen pressure (TcPO(2)) (15.6 +/-12 mm Hg vs 26 +/-16, p = 0.07). ESRD implies a poor prognosis in patients with stage IV peripheral arterial disease.

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End-stage renal disease—Is infrainguinal limb revascularization justified?

Cited by 70 publications

References 7 publications

Predictors of amputation and survival following lower extremity revascularization in hemodialysis patients

Predictors of amputation and survival following lower extremity revascularization in hemodialysis patients

Impact of Renal Insufficiency on Short-Term Morbidity and Mortality after Lower Extremity Revascularization

Foot Gangrene in Patients with End-Stage Renal Disease: A Case Control Study

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