Outcome of infrainguinal revascularization for critical limb ischemia in diabetics with end stage renal disease

Sigala, Fragiska; Georgopoulos, Sotiris; Langer, S.; Baunach, C.; Papalambros, Efstathios; Sigalas, Konstantinos; Bramis, John; Bakoyiannis, Christos; Bastounis, Effie; Hepp, W.

doi:10.1024/0301-1526.35.1.15

Cited by 23 publications

(21 citation statements)

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“…Thus, the amputation rate observed in our present series is well comparable with recent reports on surgical revascularization in CLI patients with RI. 29,30 O'Hare analyzed 9932 patients undergoing surgical revascularization for PAD in VA hospitals. 3 In total, 11% of patients in that study underwent major lower extremity amputation within 1 year after surgical revascularization: 10% of patients with normal renal function, 11% of patients with moderate RI, 12% of patients with severe RI, and 29% of patients receiving dialysis.…”

Section: Discussionmentioning

confidence: 99%

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

Willenberg¹,

Baumann²,

Eisenberger³

et al. 2011

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

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

Willenberg¹,

Baumann²,

Eisenberger³

et al. 2011

Journal of Vascular Surgery

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“…Such a risk increased dramatically along with CKD classes (CKD class 3: rr 1.62; CKD class 4: rr 2.85; CKD class 5: rr 3.75). Indeed, such a mortality risk is particularly high after lower limb revascularization as pooled analysis of surgical series showed a 30-day mortality rate of 5% (4), and some more recent studies including endovascular treatment reported immediate mortality rates of about 10% (14,15). Even more dramatic is the increased risk of late mortality in these patients, which suggests that CLI is a malignant condition in ESrD patients.…”

Section: Discussionmentioning

confidence: 99%

End-Stage Renal Disease and Critical Limb Ischemia: A Deadly Combination?

et al. 2012

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Objectives: this study was planned to evaluate the prognostic impact of end-stage renal disease (esrd) in patients with critical leg ischemia (cli) undergoing infrainguinal revascularization.Materials and Methods: 1425 patients who underwent infrainguinal revascularization for cli were the subjects of the present analysis. ninety-five patients had esrd (egFr < 15 ml/min/m 2 ), and of them 66 (70%) underwent percutaneous transluminal angioplasty and 29 (30%) underwent bypass surgery.Results: esrd patients had significantly lower overall survival (at 3-year, 27.1% vs. 59.7%, p < 0.0001), leg salvage (at 3-year, 57.7% vs. 83.0%, p<0.0001), and amputation free survival (at 3-year, 16.2% vs. 52.9%, p < 0.0001) than patients with no or less severe renal failure. the difference in survival was even greater between 86 one-to-one propensity matched pairs (at 3-year, 23.1% vs. 67.3%, p < 0.0001). esrd was an independent predictor of all-cause mortality (rr 2.46, 95%ci 1.85-3.26). logistic regression showed that age ≥ 75 years was the only independent predictor of 1-year all-cause mortality (Or 4.92, 95%ci 1.32-18.36). classification and regression tree analysis showed that age ≥ 75 years and, among younger patients, bypass surgery for leg ulcer and gangrene were associated with significantly higher 1-year mortality Conclusions: lower limb revascularization in patients with cli and end-stage renal failure is associated with favourable leg salvage. however, these patients have a very poor survival and this may jeopardize any attempt of revascularization. Further studies are needed to identify esrd patients with acceptable life expectancy and who may benefit from lower limb revascularization.

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“…There is now accumulating experience with PTA, which confirms that the technique yields favourable results in patients with critical limb ischaemia [19]. By-pass graft surgery has also been extensively practised [6,20,21]. Since atherosclerosis mainly affects the infra-popliteal arteries, by-pass grafting usually has to be performed to distal arteries, such as the dorsalis pedis artery [20,21].…”

Section: Established Treatment Of Ischaemiamentioning

confidence: 93%

“…By-pass graft surgery has also been extensively practised [6,20,21]. Since atherosclerosis mainly affects the infra-popliteal arteries, by-pass grafting usually has to be performed to distal arteries, such as the dorsalis pedis artery [20,21]. In a recent cohort study of patients with critical ischaemia, revascularisation by either of the 2 modalities was feasible in most cases and succeeded in a low rate of early major amputation [22].…”

Section: Established Treatment Of Ischaemiamentioning

confidence: 98%

Advances in Treating the Ischaemic Diabetic Foot

Παπάνας

Maltezos²

2008

CVP

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The diabetic foot remains a major cause of morbidity worldwide. Ischaemia due to peripheral arterial disease significantly contributes to its pathogenesis and natural history. Increased revascularisation has been decisive in improving outcomes. However, there is still a need for further improvement. Advances in the treatment of ischaemia in the diabetic foot include therapeutic angiogenesis, stem cell therapy and miscellaneous modalities. Angiogenesis has yielded encouraging results in the treatment of peripheral arterial disease, but it has not been studied enough in patients with diabetes. Choice of patients, reliable study endpoints, as well as safety of growth factors in diabetic patients, who have an excess risk of widespread vascular disease, need to be addressed more convincingly. Similar improvement is required in the other emerging therapeutic options. From a practical point of view, until novel modalities are available, increased vigilance and prompt aggressive revascularisation are indispensable to reduce the rate of amputations.

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Outcome of infrainguinal revascularization for critical limb ischemia in diabetics with end stage renal disease

Abstract: Diabeticpatients with ESRD attained an acceptable graft patency and limb salvage but they sustained higher perioperative mortality and morbidity and reduced survival.

Cited by 23 publications

References 0 publications

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

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

End-Stage Renal Disease and Critical Limb Ischemia: A Deadly Combination?

Advances in Treating the Ischaemic Diabetic Foot

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