Outcome of infrainguinal bypass surgery for critical leg ischaemia in patients with chronic renal failure.
OBJECTIVE
To determine whether infrainguinal bypass surgery is worthwhile in patients with critical limb ischaemia (CLI) and chronic renal failure.


METHODS
Longitudinal observational study.


METHODS
Twenty-two patients with moderate renal failure indicated by serum creatinine level above 150 mumol/l, 10 patients with end-stage renal disease requiring dialysis, and three patients with functioning kidney transplant, underwent 39 bypass procedures for critical limb ischaemia.


RESULTS
Six femoropopliteal, 14 femorocrural and 19 femoropedal bypasses were performed. The immediate, 1-month, and 1-year primary patency rates were 97%, 84% and 70%, respectively. The limb salvage was 93% at 1-month and 72% at 1-year follow-up. One-year patency and leg salvage rates were 81% and 79% in non-dialysis patients, and 47% and 37% in dialysis patients. At 1-year follow-up, 55% of surviving patients had salvaged limbs. None of the patients in dialysis was alive with salvaged legs 4 months after revascularisation. Among preoperative risk factors, only serum creatinine showed a statistical significance in predicting leg salvage and survival.


CONCLUSIONS
As the outcome of patients on dialysis is very poor after infrainguinal bypass grafting, revascularisation is seldom indicated. On the contrary, leg salvage can achieve good results in patients not requiring dialysis.
Peltonen
S
S
Department of Surgery, Helsinki University Central Hospital, Finland.
Biancari
F
F
Lindgren
L
L
Mäkisalo
H
H
Honkanen
E
E
Lepäntalo
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000378:metabolism; D000075202:Contraindications; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000378:metabolism; D011183:Postoperative Complications; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects
D010758:Phosphorus; D002118:Calcium