Impact of renal insufficiency on clinical outcomes in patients with critical limb ischemia undergoing endovascular revascularization

Willenberg, Torsten; Baumann, Frederic; Eisenberger, Ute; Baumgartner, Iris; Do, Dai-Do; Diehm, Nicolas

doi:10.1016/j.jvs.2011.01.062

Cited by 31 publications

(32 citation statements)

References 37 publications

(53 reference statements)

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“…However, data on the relationship between the incidence of SFA restenosis and CKD are limited (13, 17, 18). A retrospective study by Willenberg et al reviewed the impact of renal insufficiency on clinical outcomes among patients treated with endovascular revascularization for CLI (19). In their study, creatinine clearance was a significant predictor for mortality at 1-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Superficial Femoral Artery Restenosis

Miller

Takahashi

Harmsen

et al. 2017

Journal of Vascular and Interventional Radiology

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Purpose To determine the predictors of restenosis, major adverse limb events (MALE), postoperative death (POD), and all-cause mortality after repeat endovascular treatment of superficial femoral artery (SFA) restenosis. Materials and Methods This is a retrospective review of 440 patients with 518 SFA lesions treated between January 2002 and October 2011. Ninety-six limbs were treated for restenosis with bare metal stents (BMS) or angioplasty (PTA) of which 28 limbs developed another restenosis requiring a third procedure. The interaction measured in this study was between the second and third intervention. Predictors of SFA patency, major adverse limb events (MALE), postoperative death (POD), and all-cause mortality after SFA restenosis treatment were identified. Results Patients treated with BMS (n = 51) had similar rates of restenosis compared to PTA (n = 45) (Hazard ratio [HR] 1.40; 95% confidence interval [CI] 0.68–2.90; P = 0.37). Patients in the BMS group taking statins had a significantly decreased risk of restenosis compared to patients not taking statins (HR 0.13; 95% CI 0.04–0.41; P < 0.001). Stage 4–5 chronic kidney disease (CKD) (n = 12) was associated with a significantly higher risk of MALE + POD (HR 6.17; 95% CI 1.45–26.18; P = 0.014) and all-cause mortality (HR 2.83; 95% CI 1.27–6.33; P = 0.01). Clopidogrel was protective against all-cause mortality (HR 0.41; 95% CI 0.20–0.80; P = 0.01). Conclusion Patients taking statins at the time of intervention in the BMS group had a significantly decreased risk of developing restenosis. Stage 4–5 CKD was a risk factor for MALE+POD and all-cause mortality while clopidogrel decreased all-cause mortality risk.

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Section: Discussionmentioning

confidence: 99%

Treatment of Superficial Femoral Artery Restenosis

Miller

Takahashi

Harmsen

et al. 2017

Journal of Vascular and Interventional Radiology

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“…Patients with critical limb ischemia (CLI), arguably the most morbid form of PAD, have a significant burden of AKI risk factors . The rates of diabetes and CKD in unselected studies of the CLI population have been reported to be 30–60% and 10–40%, respectively . Patients with CLI and tissue loss are also exposed to additional nephrotoxic agents such as antibiotic therapy which may also adversely influence renal function.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury following peripheral angiography and endovascular therapy: A systematic review of the literature

Prasad

Ortiz-López

Khan

et al. 2016

Cathet Cardio Intervent

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“…Also, patients with claudication undergoing treatment were not included (26). Willenberg et al prospectively followed 208 patients who underwent endovascular treatment and revealed that renal insufficiency was an independent predictor of mortality in CLI patients undergoing endovascular treatment (27). Again, patients with claudication were not included in this study.…”

Section: Discussionmentioning

confidence: 99%

Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease

Heideman

Rajebi

McKusick

et al. 2016

Journal of Vascular and Interventional Radiology

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Purpose To evaluate the effect of chronic kidney disease (CKD) on all-cause mortality, major adverse limb event (MALE), MALE + POD (post-procedure death), and amputation after endovascular treatment of superficial femoral (SFA) or popliteal arterial atherosclerotic disease. Materials and Methods A retrospective review from January 2002 to October 2011 was performed of four hundred forty patients who underwent endovascular treatment of symptomatic SFA or popliteal atherosclerotic disease for claudication (N=251) or critical limb ischemia (CLI) (N=267). CKD stage was divided based on the Kidney Dialysis Outcomes Quality Initiative (KDOQI) classification. The outcomes and factors associated with amputation, MALE, and MALE + POD were determined. Results Patients with a diagnosis of diabetes [HR=2.2; 95% CI (1.3–3.6), P=0.002] and a run off score of 0 or 1 [HR=2.0; 95% CI (1.2–3.4), P=0.01] relative to run off score of 3 were at increased risk of amputation. A patient with a baseline GFR of less than 45 had a 17% increase in amputation for every 5 point decrease less than 45 [95% CI (1.09–1.26), P<0.001]. An increase of 10 years in age, [HR=1.9, 95% CI (1.5–2.3), P<0.001], a TASC class of C/D relative to A/B [HR=1.6, 95% CI (1.1–2.2), P=0.01], and CLI [HR=2.4, 95% CI (0.5–0.9), P<0.001] were associated with increased mortality. A female gender was associated with a decreased risk of mortality [HR=0.7, 95% CI (0.5–0.9), P=0.01)]. Conclusion Worsening CKD is associated with higher amputation rates, all-cause mortality, and MALE + POD in patients undergoing endovascular treatment of SFA or popliteal disease.

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Impact of renal insufficiency on clinical outcomes in patients with critical limb ischemia undergoing endovascular revascularization

Abstract: While functional lower limb outcomes were not influenced by renal function in this study, presence of RI was an independent predictor for higher mortality in CLI patients undergoing endovascular revascularization.

Cited by 31 publications

References 37 publications

Treatment of Superficial Femoral Artery Restenosis

Treatment of Superficial Femoral Artery Restenosis

Acute kidney injury following peripheral angiography and endovascular therapy: A systematic review of the literature

Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease

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