Infrainguinal arterial reconstruction for limb salvage in patients with end-stage renal disease.
OBJECTIVE
to evaluate the efficacy of infrainguinal bypass for limb-threatening ischaemia in patients with end-stage renal disease (ESRD).


METHODS
from 1991 through 2000, 28 limbs in 22 patients with ESRD received 33 infrainguinal bypasses, while 65 limbs in 57 patients with functioning kidneys underwent 77 bypasses for limb salvage. The prevalence of diabetes is higher in the ESRD group (p = 0.03).


RESULTS
perioperative mortality and patient survival rate in the follow-up period were significantly poorer in patients with ESRD (18% vs 0%; p = 0.001, and 45% vs 85%, p < 0.001, respectively). Most causes of death were related to atherosclerosis or respiratory diseases. In spite of no significant difference in 2-year primary and secondary graft patency rates and limb salvage between the ESRD and non-ESRD groups (76% vs 83%; p = 0.12, 85% vs 91%; p = 0.06, and 83% vs 93%; p = 0.06, respectively), two cases of early limb loss occurred as a result of uncontrolled infection in the ESRD group. In contrast to autogenous conduits, nonautogenous conduits revealed a poorer outcome in ESRD patients (p = 0.03).


CONCLUSIONS
perioperative mortality and patient survival rate were significantly poorer in the ESRD group. Preoperative full evaluation of myocardial and brain ischaemia, revascularisation with autogenous conduits, appropriate treatment of wound infection, and strict follow-up for accompanying diseases may be needed in these patients.
Kimura
H
H
Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Miyata
T
T
Sato
O
O
Furuya
T
T
Iyori
K
K
Shigematsu
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001162:Arteriosclerosis Obliterans / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome