title: In-hospital outcomes in patients with critical limb ischemia and end-stage renal disease after revascularization.
abstract: OBJECTIVE
  Analysis of in-hospital outcomes in patients treated for critical limb ischemia (CLI) and end-stage renal disease (ESRD) compared to CLI patients with normal renal function.
  
  
  METHODS
  A subgroup analysis of the German CRITISCH registry, a prospective multicenter registry, assessing the first-line treatment strategies in CLI patients in 27 vascular centers in Germany was performed. The study cohort was divided into ESRD patients (n = 102) and patients with normal renal function (n = 674; glomerular filtration rate >60/mL/min/1.73 m(2)). The following first-line treatment strategies were assessed: endovascular therapy (EVT), bypass surgery, patch plasty, and no vascular intervention (conservative treatment, primary amputation). Uni- and multivariate analyses were performed to identify differences between groups as to six end points: amputation or death (composite end point), amputation, death, hemodynamic failure, major adverse cardiac and cerebrovascular events, and reintervention.
  
  
  RESULTS
  Differences between the ESRD and non-ESRD group were found regarding the applied first-line therapy (P = .016): The first-line treatment strategies in ESRD patients were EVT in 64% (n = 65), bypass surgery in 13% (n = 13), patch plasty in 11% (n = 11), and no vascular intervention in 13% (n = 13). In non-ESRD patients, EVT was applied in 48% (n = 326), bypass surgery in 27% (n = 185), patch plasty in 13% (n = 86), and no vascular intervention in 11% (n = 77). For ESRD patients, a noticeably increased risk of the composite end point (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.19-5.79; P = .017), amputation (OR, 3.14; 95% CI, 1.35-7.31; P = .008), and hemodynamic failure (OR, 2.19; 95% CI, 1.19-4.04; P = .012) was observed.
  
  
  CONCLUSIONS
  CLI patients on dialysis represent a challenging cohort prone to in-hospital death, amputation, and hemodynamic failure. Two-thirds of these high-risk patients are treated with EVT. Present data suggest that this modality is generally considered as the most favorable treatment option in this patient subgroup.
authors: Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany. Electronic address: alexander.meyer@uk-erlangen.de.
authors: Alexander
authors: A
authors: Meyer
authors: Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany.
authors: Werner
authors: W
authors: Lang
authors: Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany.
authors: Matthias
authors: M
authors: Borowski
authors: Clinic for Vascular and Endovascular Surgery, University Clinic of Muenster, and Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany.
authors: Giovanni
authors: G
authors: Torsello
authors: Clinic for Vascular and Endovascular Surgery, University Clinic of Muenster, and Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany.
authors: Theodosios
authors: T
authors: Bisdas
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D016009:Chi-Square Distribution; D016638:Critical Illness; D018572:Disease-Free Survival; D057510:Endovascular Procedures; D005260:Female; D005858:Germany; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality