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Infrainguinal endovascular and bypass surgery for critical leg ischemia in patients on long-term dialysis

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Annals of Vascular Surgery

Abstract

Lower limb revascularization has been shown to be worthwhile for treatment of critical leg ischemia in uremic patients, but poor results are expected in patients on long-term dialysis. We have retrospectively evaluated the results of a series of 21 consecutive patients on long-term dialysis who underwent 20 infrainguinal bypass graft and 5 endovascular procedures for critical leg ischemia to identify factors contraindicating any infrainguinal revascularization attempt in this patient population. At 2-year follow-up, the patency rate was 74%, leg salvage rate was 85%, and survival rate was 23%, whereas 23% of patients were alive with salvaged leg. Patients on hemodialysis achieved better survival outcome than patients on peritoneal dialysis (p=0.02). Multivariate analysis showed that low serum level of albumin (p=0.009; p=0.005) and coronary artery disease (p=0.0002; p=0.001) had an adverse effect on the survival rate and on the rate of patients alive with salvaged leg, respectively. Patients without coronary artery disease achieved an alive-with-salvaged-leg rate at 1- and 2-year follow-up of 68% and 41%, respectively, whereas 12% of patients with coronary artery disease survived with salvaged leg after 1 year, but none of them survived with salvaged leg at 2-year follow-up (p=0.003). In conclusion, infrainguinal revascularization for lower extremity ischemia in dialysis patients is hardly indicated in the presence of coronary artery disease and severe hypoalbuminemia.

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References

  1. Jungers P, Massy ZA, Nguyen Khoa T, et al. incidence and risk factors of atherosclerotic cardiovascular accidents in predialysis chronic renal failure patients: a prospective study. Nephrol Dial Transplant 1997; 12: 2597–2602.

    Article  PubMed  CAS  Google Scholar 

  2. Herzog CA, Ma JZ, Collins JA. Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med 1998; 339: 799–805.

    Article  PubMed  CAS  Google Scholar 

  3. Harrington EB, Harrington ME, Schanzer H, Haimov M. End-stage disease — is infrainguinal limb revascularization justified? J Vasc Surg 1990; 12: 691–696.

    Article  PubMed  CAS  Google Scholar 

  4. Peltonen S, Biancari F, Lindgren L, Mäkisalo H, Honkanen E, Lepäntalo M. Outcome of infrainguinal bypass surgery for critical leg ischaemia in patients with chronic renal failure. Eur J Vasc Endovasc Surg 1998; 15: 122–127.

    Article  PubMed  CAS  Google Scholar 

  5. European Working Group on Critical Leg Ischaemia. Chronic leg ischaemia. Eur J Vasc Surg 1992; 6(Suppl. A): 1–32.

    Google Scholar 

  6. Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997; 26: 517–538.

    Article  PubMed  CAS  Google Scholar 

  7. Chang BB, Paty PS, Shah DM, Kaufman JL, Leather RP. Result of infrainguinal bypass for limb salvage in patients with end-stage renal disease. Surgery 1990; 108: 742–747.

    PubMed  CAS  Google Scholar 

  8. Edwards JM, Taylor LM, Porter JM. Limb salvage in endstage renal disease (ESRD). Arch Surg 1998; 123: 1164–1168.

    Google Scholar 

  9. Johnson BL, Glickman MH, Bandyk DF, Esses GE. Failure of foot salvage in patients with end-stage renal disease after surgical revascularization. J Vasc Surg 1995; 22: 280–286.

    Article  PubMed  CAS  Google Scholar 

  10. Sanchez LA, Goldsmith J, Rivers SP, Panetta TF, Wengerter KR, Veith FJ. Limb salvage surgery in end stage renal disease: is it worthwhile? J Cardiovasc Surg 1992; 33: 344–348.

    CAS  Google Scholar 

  11. Wassermann RJ, Saroyan RM, Rice JC, Kerstein MD. Infrainguinal revascularization for limb salvage in patients with end stage renal disease. South Med J 1991; 84: 190–192.

    PubMed  CAS  Google Scholar 

  12. Whittemore AD, Donaldson MC, Mannick JA. Infrainguinal reconstruction for patients with chronic renal insufficiency. J Vasc Surg 1993; 17: 32–41.

    Article  PubMed  CAS  Google Scholar 

  13. Vanrenterghem Y, Jones EH. Report on management of renale failure in Europe, XXVI, 1995. Report based on the Centre Questionnaire, 1995. The ERA-EDTA Registry. Nephrol Dial Transplant 1996; 11 (Suppl. 7): 28–32.

    PubMed  Google Scholar 

  14. Ritz E, Lippert J, Keller C. Hypertension, cardiovascular complications and survival in diabetic patients on maintenance haemodialysis. Nephrol Dial Transplant 1995; 10 (Suppl. 7): 43–46.

    PubMed  Google Scholar 

  15. Pollock CA, Ibels LS, Allen BJ. Nutritional markers and survival in maintenance dialysis patients. Nephron 1996; 74: 625–641.

    Article  PubMed  CAS  Google Scholar 

  16. Arora P, Strauss BJ, Borovnicar D, Stroud D, Atkins RC, Kerr PG. Total body nitrogen predicts long-term mortality in haemodialysis patients—a single-centre experience. Nephrol Dial Transplant 1998; 13: 1731–1736.

    Article  PubMed  CAS  Google Scholar 

  17. Avram MM, Mittman N, Bonomini L, Chattopadhyay J, Fein P. Markers for survival in dialysis: a seven-year prospective study. Am J Kidney Dis 1995; 26: 209–219.

    Article  PubMed  CAS  Google Scholar 

  18. Owen WF Jr, Lew NL, Liu Y, Lowrie EG, Lazarus JM. The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 1993; 329: 1001–1006.

    Article  PubMed  Google Scholar 

  19. Isiklar MH, Kulbashi M, MacDonald MJ, Lumsden AB. Infrainguinal hypass in end-stage renal disease: when is it justified? Semin Vasc Surg 1997; 110: 42–48.

    Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland

    Wolf-Dieter Roth & Johan Edgren

  2. Department of Vascular Surgery, Meilahti Hospital, Helsinki University Central Hospital, PO Box 262, 00029, HYKS, Finland

    Fausto Biancari, Ilkka Kantonen, Sorjo Mätzke, Anders Albäck & Mauri Lepäntalo

Authors
  1. Fausto Biancari
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  2. Ilkka Kantonen
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  3. Sorjo Mätzke
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  4. Anders Albäck
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  5. Wolf-Dieter Roth
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  6. Johan Edgren
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  7. Mauri Lepäntalo
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Correspondence to Mauri Lepäntalo.

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Biancari, F., Kantonen, I., Mätzke, S. et al. Infrainguinal endovascular and bypass surgery for critical leg ischemia in patients on long-term dialysis. Annals of Vascular Surgery 16, 210–214 (2002). https://doi.org/10.1007/s10016-001-0161-1

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  • DOI: https://doi.org/10.1007/s10016-001-0161-1

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