Risk factors for survival in patients with end-stage renal disease undergoing infrainguinal bypass surgery.
BACKGROUND
A poor longevity and high perioperative morbidity make lower extremity revascularization questionable in patients with end-stage renal disease (ESRD). Therefore, careful selection of patients for surgery is essential. Aim of this study was to assess negative predictors of survival in patients with ESRD undergoing infrainguinal bypass grafting for critical limb ischemia (CLI).


METHODS
We reviewed the records of 49 consecutive patients with ESRD who underwent infrainguinal bypass grafting for limb salvage. Rates were computed with life-table analysis and compared by log-rank test. Effects of demographic and disease variables on the survival rate were evaluated by Cox proportional hazard regression model.


RESULTS
Indications for surgery were rest pain in two (4.1%) and tissue loss in 4 7 patients (95.9%). Median follow up was 7.8 months (IQR, 2.43 to 16.23). Perioperative (30-day) morbidity and mortality for all patients were 6.1% and 12.2%, respectively. Primary and secondary patency at two years both were 81.4%. Cumulative survival rate at two years and four years were 24.9% and 9.3%, respectively Limb salvage rate and amputation-free survival rate at two and four years were 80.4%, 53.6%, 21.8% and 14.6%, respectively. Myocardial infarction and congestive heartfailure in the patients medical history both had an adverse effect on survival rate with a hazard ratio of 5.52 (95% CI, 1.94 to 15.69) and 3.12 (95% CI, 0.99 to 9.81), respectively.


CONCLUSIONS
In the presence of myocardial infarction or congestive heart failure in the medical history survival rate is especially poor for patients with ESRD undergoing infrainguinal revascularization. Therefore, bypass surgery for CLI is hardly indicated in this group of patients.
Engelhardt
M
M
Section of Vascular Surgery, Department of Surgery, Military Hospital Ulm, Germany. m-engelhardt@web.de
Bruijnen
H
H
Schaal
J
J
Wölfle
K D
KD
D000368:Aged; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007264:Inguinal Canal / Q000098:blood supply / Q000601:surgery; D007511:Ischemia / Q000453:epidemiology* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*