title: End-stage renal disease and critical limb ischemia: a deadly combination?
abstract: OBJECTIVE
  This study was planned to evaluate the prognostic impact of end-stage renal disease (ESRD) in patients with critical leg ischemia (CLI) undergoing infrainguinal revascularization.
  
  
  METHODS
  1425 patients who underwent infrainguinal revascularization for CLI were the subjects of the present analysis. Ninety-five patients had ESRD (eGFR < 15 ml/min/m²), and of them 66 (70%) underwent percutaneous transluminal angioplasty and 29 (30%) underwent bypass surgery.
  
  
  RESULTS
  ESRD patients had significantly lower overall survival (at 3-year, 27.1% vs. 59.7%, p < 0.0001), leg salvage (at 3-year, 57.7% vs. 83.0%, p < 0.0001), and amputation free survival (at 3-year, 16.2% vs. 52.9%, p < 0.0001) than patients with no or less severe renal failure. The difference in survival was even greater between 86 one-to-one propensity matched pairs (at 3-year, 23.1% vs. 67.3%, p < 0.0001). ESRD was an independent predictor of all-cause mortality (RR 2.46, 95%CI 1.85-3.26). Logistic regression showed that age ≥ 75 years was the only independent predictor of 1-year all-cause mortality (OR 4.92, 95%CI 1.32-18.36). Classification and regression tree analysis showed that age ≥ 75 years and, among younger patients, bypass surgery for leg ulcer and gangrene were associated with significantly higher 1-year mortality
  
  
  CONCLUSIONS
  Lower limb revascularization in patients with CLI and end-stage renal failure is associated with favourable leg salvage. However, these patients have a very poor survival and this may jeopardize any attempt of revascularization. Further studies are needed to identify ESRD patients with acceptable life expectancy and who may benefit from lower limb revascularization.
authors.affiliation: Division of Cardio-Thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
authors.forename: F
authors.initials: F
authors.lastname: Biancari
authors.forename: E
authors.initials: E
authors.lastname: Arvela
authors.forename: M
authors.initials: M
authors.lastname: Korhonen
authors.forename: M
authors.initials: M
authors.lastname: Söderström
authors.forename: K
authors.initials: K
authors.lastname: Halmesmäki
authors.forename: A
authors.initials: A
authors.lastname: Albäck
authors.forename: M
authors.initials: M
authors.lastname: Lepäntalo
authors.forename: M
authors.initials: M
authors.lastname: Venermo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017130:Angioplasty / Q000401:mortality; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D023821:Limb Salvage / Q000401:mortality; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D057216:Propensity Score; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000401:mortality