Outcomes of Critical Limb Ischemia in Hemodialysis Patients After Distal Bypass Surgery　– Poor Limb Prognosis With Stage 4 Wound, Ischemia, and Foot Infection (WIfI) –

Hoshina, Katsuyuki; Yamamoto, Kota; Miyata, Tetsuro; Watanabe, Toshiaki

doi:10.1253/circj.cj-16-0591

Cited by 21 publications

(15 citation statements)

References 29 publications

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“…Consistent with the results of the preliminary in-hospital outcomes, 1 the major amputation rate was significantly higher in the ESRD group, so a combination of both elevated risk of death and adverse limb events appears to be responsible for worse results in ESRD, which is also in congruence with current literature. 9 Against this background, we hypothesize that one reason for this finding might be the advanced soft tissue loss and wound infection of dialysis patients at first presentation, 10 leading to higher hazard of hemodynamic failure and subsequent major amputation during follow-up; the fact that dialysis patients may require major amputation despite patent grafts is well documented in the literature. 11 Of note, this issue was outside the topic of this study, but the findings of our study that rates of reintervention did not hold significant differences between ESRD and non-ESRD in 24 months of follow-up fit well to this hypothesis.…”

Section: Discussionmentioning

confidence: 97%

“…11 Of note, this issue was outside the topic of this study, but the findings of our study that rates of reintervention did not hold significant differences between ESRD and non-ESRD in 24 months of follow-up fit well to this hypothesis. Recent work reporting no difference in graft patency rates after surgical revascularization between ESRD and non-ESRD supports these assumptions 9,12 and indicates that major amputation in dialysis might be due to local infection and advanced tissue necrosis rather than occluded vascular reconstructions. In this context, a possible explanation for nondiffering rates of reintervention between cohorts might be the increased mortality in ESRD in the sense that a major portion of dialysis patients might not experience vascular complications as restenosis or graft occlusion because of premature death.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of dialysis patients with critical limb ischemia after revascularization compared with patients with normal renal function

Meyer

Fießler

Stavroulakis

et al. 2018

Journal of Vascular Surgery

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Two-year AFS, overall survival, and freedom from major amputation were decreased in ESRD patients compared with non-ESRD patients with critical limb ischemia. Cardiovascular comorbidities were without significant impact on outcome parameters, whereas choice of treatment modality within the ESRD group did not influence AFS. Decision-making in ESRD as to choice of therapeutic approach in dialysis patients should notably account for the individual's lesion characteristics and vascular disease; surgical revascularization and EVT may be used as complementary options.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Outcomes of dialysis patients with critical limb ischemia after revascularization compared with patients with normal renal function

Meyer

Fießler

Stavroulakis

et al. 2018

Journal of Vascular Surgery

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“…8 Research in various countries has been conducted of the WIfI classification system to verify the rationality and validity of the assessment tool in actual clinical practice. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] WIfI has been useful for assessing 1-year amputation-free survival, predicting wound healing, and facilitating treatment strategy development.…”

mentioning

confidence: 99%

Utility of skin perfusion pressure values with the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification system

Kimura

Watanabe

Tokuoka

et al. 2019

Journal of Vascular Surgery

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Objective: The addition of skin perfusion pressure (SPP) might enhance the predictive value of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system. The purpose of the present study was to evaluate the SPP for each WIfI classification stage among patients with foot wounds by cross-referencing the results of prospectively monitored limb outcomes and to derive the SPP criteria that could be combined with other measurements to grade ischemia for the WIfI classification.Methods: From July 2015 to June 2017, patients with foot wounds that met the WIfI classification criteria were prospectively enrolled. We assessed the limbs using the WIfI ischemia grade without measuring the transcutaneous oxygen pressure but measured the SPP. After monitoring for 1 year, the predictability of the WIfI stages was analyzed according to whether the limbs had not healed (unchanged or worsened wounds, minor or major amputation, all-cause death) or had healed (improved or healed wounds) by comparing stages 1 and 2 with stages 3 and 4. We also statistically analyzed the SPP values that could be the boundary values between each ischemia grade and reevaluated the predictability of the WIfI stages with the boundary SPP values.Results: We enrolled a total of 91 limbs for 76 patients (mean age, 70.5 6 12.0 years). The mean SPP values stratified by ischemia grade 0 to 3 were 52.1, 41.1, 27.1, and 18.8 mm Hg, respectively (an SPP of <30 mm Hg indicates severe ischemia). After monitoring for 1 year, 19 of 48 limbs in stage 1 and 2 and 35 of 43 in stage 3 and 4 were in the nonhealed group and 29 limbs in stage 1 and 2 and 8 limbs in stage 3 and 4 were in the healed group. The SPP boundary values between each ischemia (I) grade were calculated as 45 mm Hg for I-0/I-1, 35 for I-1/I-2, and 25 for I-2/I-3. When jointly using the boundary SPP values, the ischemia grade changed for 23 limbs, altering the distribution of the WIfI stages and limb outcomes: 11 of 38 limbs in stage 1 and 2 and 43 of 53 in stage 3 and 4 were transferred to the nonhealed group. The sensitivity, efficiency, and negative predictive value of WIfI staging improved when staging with SPP: from 65% to 80%, 70% to 77%, and 60% to 71%, respectively. Conclusions:The SPP boundary values that could be used with ischemia grade in the WIfI classification were identified as 45, 35, and 25 mm Hg. The addition of SPP could improve the accuracy of the evaluation.

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“…Of these 20 studies, 16 studies evaluated the post‐operative outcomes following angioplasty or bypass in ESRD and non‐ESRD patients with CLI while four of the studies compared angioplasty to bypass in ESRD patients with CLI. The patient populations in each study had CLI defined as tissue loss, ischemic rest pain, non‐healing ulcers, or gangrene, using the Rutherford classification 1,3,4,19 . The TransAtlantic Inter‐Society Consensus (TASC) guidelines were used to diagnose CLI in two studies 14,18 .…”

Section: Resultsmentioning

confidence: 99%

End‐stage renal disease patients undergoing angioplasty and bypass for critical limb ischemia have worse outcomes compared to non‐ESRD patients: Systematic review and meta‐analysis

Dawson

Telles-Garcia

Atkins

et al. 2021

Cathet Cardio Intervent

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Background End‐stage renal disease (ESRD) is associated with increased morbidity and mortality following lower extremity amputation for critical limb ischemia (CLI). Angioplasty and bypass are used in ESRD patients with CLI; however, the treatment of choice remains controversial. We compared the long‐term outcomes in patients with CLI undergoing angioplasty or bypass to evaluate the differences between patients with ESRD and those without ESRD. Methods Established databases were searched for observational studies comparing outcomes following bypass or angioplasty for CLI in patients with ESRD to those in non‐ESRD patients. End points included survival, limb salvage, amputation‐free survival (AFS), and primary and secondary patency at 1‐year post‐procedure. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effect model. Results We included 20 studies with a total of 24,851 patients. ESRD patients compared to non‐ESRD patients with CLI had significantly lower survival post‐angioplasty (OR 0.51, 95% CI 0.36–0.72, p < .001) and post‐bypass (OR 0.26, 95% CI 0.15–0.45, p < .001). ESRD patients had lower rates of limb salvage post‐bypass (OR 0.33, 95% CI 0.21–0.53, p < .001) and post‐angioplasty (OR 0.54, 95% CI 0.41–0.70, p < .001). AFS was significantly lower in ESRD patients compared to non‐ESRD patients following angioplasty (OR 0.48, 95% CI 0.32–0.71, p < .001) and bypass (OR 0.28, 95% CI 0.16–0.47, p < .001) despite no significant differences in primary patency. ESRD patients had overall worse secondary patency post‐angioplasty and/or bypass (OR 0.54, 95% CI 0.32–0.94, p = .03) compared to non‐ESRD patients. A meta‐analysis of four studies directly comparing survival in ESRD patients with CLI based on whether they underwent angioplasty or bypass showed no difference (OR 0.93, 95% CI 0.64–1.35, p = .69). Conclusion ESRD patients have worse survival, limb salvage, and AFS outcomes following angioplasty and bypass for CLI compared to non‐ESRD patients. Large randomized controlled trials comparing these two modalities of treatment in this patient population are needed for further clarity.

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Outcomes of Critical Limb Ischemia in Hemodialysis Patients After Distal Bypass Surgery　– Poor Limb Prognosis With Stage 4 Wound, Ischemia, and Foot Infection (WIfI) –

Cited by 21 publications

References 29 publications

Outcomes of dialysis patients with critical limb ischemia after revascularization compared with patients with normal renal function

Outcomes of dialysis patients with critical limb ischemia after revascularization compared with patients with normal renal function

Utility of skin perfusion pressure values with the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification system

End‐stage renal disease patients undergoing angioplasty and bypass for critical limb ischemia have worse outcomes compared to non‐ESRD patients: Systematic review and meta‐analysis

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Outcomes of Critical Limb Ischemia in Hemodialysis Patients After Distal Bypass Surgery – Poor Limb Prognosis With Stage 4 Wound, Ischemia, and Foot Infection (WIfI) –

Cited by 21 publications

References 29 publications

Outcomes of dialysis patients with critical limb ischemia after revascularization compared with patients with normal renal function

Outcomes of dialysis patients with critical limb ischemia after revascularization compared with patients with normal renal function

Utility of skin perfusion pressure values with the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification system

End‐stage renal disease patients undergoing angioplasty and bypass for critical limb ischemia have worse outcomes compared to non‐ESRD patients: Systematic review and meta‐analysis

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Outcomes of Critical Limb Ischemia in Hemodialysis Patients After Distal Bypass Surgery　– Poor Limb Prognosis With Stage 4 Wound, Ischemia, and Foot Infection (WIfI) –