title: Impact of end-stage renal disease in patients with critical limb ischaemia undergoing infrapopliteal intervention.
abstract: This study aimed to investigate the impact of end-stage renal disease (ESRD) on clinical outcomes following infrapopliteal intervention in critical limb ischaemia patients with tissue loss. This retrospective single-centre study enrolled 92 consecutive patients (117 limbs) undergoing infrapopliteal intervention for the treatment of ischaemic tissue loss. The primary outcomes were the wound healing rate, the clinically driven reintervention rate and the limb salvage rate. The secondary outcome was amputation-free survival. The pedal arch was significantly (p=0.002) more diseased in ESRD patients than in non-ESRD patients. ESRD patients demonstrated a significantly lower wound healing rate (hazard ratio [HR], 0.552; 95% CI: 0.319-0.957; p=0.034) and a higher reintervention rate (HR, 1.988; 95% CI: 1.135-3.482; p=0.016). However, there was no significant difference in limb salvage rate between patients with and without ESRD. Age (HR, 1.056; 95% CI: 1.020-1.094; p=0.002), ESRD (HR, 2.239; 95% CI: 1.138-4.407; p=0.020), heart failure (HR, 2.360; 95% CI: 1.295-4.302; p=0.005) and infectious wound (HR, 2.017; 95% CI: 1.145-3.552; p=0.015) were independently associated with death or major amputation. ESRD patients yielded a more affected pedal arch and were at approximately twice the risk of wound healing failure, need for reintervention, and death or major amputation compared to non-ESRD patients.
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Osami
authors.initials: O
authors.lastname: Kawarada
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yokoi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Higashimori
authors.forename: Masahiko
authors.initials: M
authors.lastname: Fujihara
authors.forename: Shingo
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000800:Angioplasty, Balloon; D003646:Debridement / Q000706:statistics & numerical data; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007511:Ischemia / Q000453:epidemiology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D011150:Popliteal Artery; D012189:Retrospective Studies; D015607:Stents; D014945:Wound Healing; D014946:Wound Infection / Q000453:epidemiology