Infrainguinal endovascular and bypass surgery for critical leg ischemia in patients on long-term dialysis.
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.
Biancari
Fausto
F
Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Kantonen
Ilkka
I
Mätzke
Sorjo
S
Albäck
Anders
A
Roth
Wolf-Dieter
WD
Edgren
Johan
J
Lepäntalo
Mauri
M
D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011150:Popliteal Artery / Q000601:surgery; D006435:Renal Dialysis; D012307:Risk Factors; D012709:Serum Albumin; D015996:Survival Rate; D014654:Vascular Patency; D014656:Vascular Surgical Procedures
D012709:Serum Albumin