Infrainguinal bypass in patients with end-stage renal disease

Baele, Henry; Piotrowski, Joseph J.; Yuhas, Joel P.; Anderson, C R; Alexander, Robert R.

doi:10.1016/s0039-6060(05)80208-9

Cited by 54 publications

(36 citation statements)

References 17 publications

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“…Yet at this time we have no actual data available to support our observation. Our primary findings are in agreement with other studies that could not prove a better survival of ESRD patients with CLI after bypass surgery [3,5,7,8], and that showed a higher amputation rate after the procedure due to bypass thrombosis [4]. Our secondary finding showed that duration of dialysis is an independent predictor of death in our patient groups, significantly increasing the risk for every dialysis year by 17% (hazard ratio 1.17, see Table 2).…”

Section: Discussionsupporting

confidence: 92%

Impact of Femoropopliteal Bypass Surgery on the Survival and Amputation Rate of End-Stage Renal Disease Patients with Critical Limb Ischemia

2007

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Section: Discussionsupporting

confidence: 92%

Impact of Femoropopliteal Bypass Surgery on the Survival and Amputation Rate of End-Stage Renal Disease Patients with Critical Limb Ischemia

2007

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“…Several papers describe the outcome of dialysis patients with PAD treated by bypass surgery [10][11][12]18]. The 2 year cumulative limb salvage rate reported has been in the range 50-85%.…”

Section: Limb Salvagementioning

confidence: 99%

“…A poor limb salvage rate after surgical revascularization has been reported, with associated high perioperative mortality [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous transluminal angioplasty is feasible and effective in patients on chronic dialysis with severe peripheral artery disease

Graziani¹,

Silvestro²,

Bertone³

et al. 2007

Nephrology Dialysis Transplantation

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Background. Peripheral arterial disease (PAD) is common among patients on chronic dialysis. Despite severe clinical manifestations, the indication for bypass surgery is controversial, because of the high morbidity and mortality rate of these patients. The less invasive percutaneous transluminal angioplasty (PTA) is a possible alternative, but data about PTA in dialysis patients are scarce. Methods. We followed 107 dialysis patients (mean age 67 AE 10, 75 males) with 132 ischaemic limbs (97% with critical limb ischaemia and ischaemic foot lesions or rest pain) consecutively treated by PTA. Results. PTA was successful in 97% of cases. Median follow-up was 22 months. Cumulative limb salvage rates at 12, 24, 36 and 48 months were 86, 84, 84 and 62%, respectively. Log-rank test showed an association between major amputation and baseline presence of foot lesions (P ¼ 0.04). This association was confirmed by a Cox survival multivariate analysis [hazard ratio (HR) ¼ 7.03, 95% confidence interval (CI) ¼ 1.1-43.0, P ¼ 0.035]. Limb salvage without any new intervention on the same leg was achieved in 70% of the cases, and was associated with the absence of diabetes mellitus (P ¼ 0.01), lower number of treated lesions (P ¼ 0.04) and proximal level (iliac and/or femoro-popliteal) of PTA (P < 0.001). Independent predictors were diabetes mellitus (HR ¼ 3.47, 95% CI ¼ 1.31-9.17, P ¼ 0.01) and proximal PTA (HR ¼ 0.28, 95% CI ¼ 0.08-0.94, P ¼ 0.04). Fiftythree (49%) patients died during follow-up. Patients older than 67 years (the median value in our sample) had a 2.4-fold increase in mortality risk (95% CI ¼ 1.4-4.1, P < 0.001).Conclusions. PTA is feasible and effective in dialysis patients with PAD, and should be preferred to other more invasive interventions.

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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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Infrainguinal bypass in patients with end-stage renal disease

Cited by 54 publications

References 17 publications

Impact of Femoropopliteal Bypass Surgery on the Survival and Amputation Rate of End-Stage Renal Disease Patients with Critical Limb Ischemia

Impact of Femoropopliteal Bypass Surgery on the Survival and Amputation Rate of End-Stage Renal Disease Patients with Critical Limb Ischemia

Percutaneous transluminal angioplasty is feasible and effective in patients on chronic dialysis with severe peripheral artery disease

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

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