Clinical Outcomes after Isolated Infrapopliteal Revascularization in Hemodialysis Patients with Critical Limb Ischemia: Endovascular Therapy versus Bypass Surgery.

Abstract

AIM:

To investigate the long-term clinical outcome of endovascular therapy (EVT) or bypass surgery in patients on hemodialysis (HD) with critical limb ischemia due to isolated infrapopliteal disease.

METHODS:

We enrolled 254 consecutive HD patients successfully undergoing infrapopliteal revascularization by EVT (126 patients) and bypass surgery (128 patients). They were followed up for five years. Amputation-free survival (AFS) and incidence of any re-intervention were evaluated. A propensity score from all baseline variables was incorporated into Cox analysis.

RESULTS:

In the EVT group, age was higher (p=0.039), diabetes and coronary artery disease were more frequent (p=0.004 and p=0.0052, respectively), and tissue loss was more rarely observed (p＜ 0.0001) than in the bypass group. During the follow-up period, 21 major amputations and 64 deaths occurred. The propensity score-adjusted AFS rate at 5 years was comparable between groups (61.0% in EVT group vs. 55.1% in the bypass group, adjusted hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.52-1.42, p=0.58). The adjusted survival rates were also similar between groups for amputation and all-cause mortality. However, freedom from any re-intervention was markedly lower in the EVT than in the bypass group (48.6% vs. 84.6%, adjusted-HR, 3.56, 95% CI 1.95-6.75, p＜ 0.0001).

CONCLUSIONS:

The rate of AFS was broadly comparable between the two strategies, although compared with bypass surgery, EVT had much higher rates for re-intervention.

• Authors: Ryuta Ito, Yoshitaka Kumada, Hideki Ishii, Daisuke Kamoi, Takashi Sakakibara, Norio Umemoto, Hiroshi Takahashi, Toyoaki Murihara
• Journal: Journal of atherosclerosis and thrombosis (J Atheroscler Thromb) Vol. 25 Issue 9 Pg. 799-807 (Sep 01 2018) ISSN: 1880-3873 [Electronic] Japan
• PMID: 29367521 (Publication Type: Journal Article)

Topics

• Aged
• Coronary Artery Bypass
• Endovascular Procedures (adverse effects)
• Female
• Follow-Up Studies
• Humans
• Ischemia (therapy)
• Lower Extremity (blood supply)
• Male
• Middle Aged
• Peripheral Arterial Disease (therapy)
• Popliteal Artery (physiopathology)
• Prognosis
• Renal Dialysis (adverse effects)
• Retrospective Studies
• Risk Factors
• Treatment Outcome