Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease.
OBJECTIVE
To evaluate effect of chronic kidney disease (CKD) on all-cause mortality, major adverse limb event (MALE), MALE and postoperative death (MALE + POD), and amputation after endovascular treatment of femoropopliteal disease.


METHODS
A retrospective review from January 2002 to October 2011 was performed of 440 patients who underwent endovascular treatment of symptomatic femoropopliteal disease for claudication (n = 251) or critical limb ischemia (CLI) (n = 267). CKD stage was divided based on Kidney Dialysis Outcomes Quality Initiative classification. Outcomes and factors associated with amputation, MALE, and MALE + POD were determined.


RESULTS
Patients with diabetes (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.3-3.6; P = .002) and runoff score of 0 or 1 (HR = 2.0; 95% CI, 1.2-3.4; P = .01) relative to runoff score of 3 were at increased risk of amputation. Patients with baseline glomerular filtration rate < 45 mL/min/1.73 m(2) had a 17% increase in amputation for every 5-point decrease < 45 mL/min/1.73 m(2) (95% CI, 1.09-1.26; P < .001). Increase of 10 years in age (HR = 1.9; 95% CI, 1.5-2.3; P < .001), TransAtlantic Inter-Society Consensus class of C/D relative to A/B (HR = 1.6; 95% CI, 1.1-2.2; P = .01), and CLI (HR = 2.4; 95% CI, 0.5-0.9; P < .001) were associated with increased mortality. Female sex was associated with decreased risk of mortality (HR = 0.7; 95% CI, 0.5-0.9; P = .01).


CONCLUSIONS
Worsening CKD is associated with higher amputation rates, all-cause mortality, and MALE + POD in patients undergoing endovascular treatment of femoropopliteal disease.
Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Paul P
PP
Heideman
Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Mohammad Reza
MR
Rajebi
Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Michael A
MA
McKusick
Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Haraldur
H
Bjarnason
Department of Radiology, Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Gustavo S
GS
Oderich
Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Jeremy L
JL
Friese
Department of Radiology, Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Mark D
MD
Fleming
Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Andrew H
AH
Stockland
Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
William S
WS
Harmsen
Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Jay
J
Mandrekar
Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Vascular and Interventional Radiology Translational Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Electronic address: misra.sanjay@mayo.edu.
Sanjay
S
Misra
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D003251:Constriction, Pathologic; D018450:Disease Progression; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D058729:Peripheral Arterial Disease / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D016016:Proportional Hazards Models; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D019233:Retreatment; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome