title: Comparison of Clinical Outcomes after Surgical and Endovascular Revascularization in Hemodialysis Patients with Critical Limb Ischemia.
abstract: OBJECTIVE
  The treatment strategy for hemodialysis (HD) patients with critical limb ischemia (CLI) has been clinically debatable. Here we compared clinical outcomes after bypass surgery (BSX) and after endovascular therapy (EVT) using propensity score matching.
  
  
  METHODS
  A retrospective multicenter database of 246 (68 BSX and 178 EVT) consecutive HD patients with CLI (79% with tissue loss) who underwent infrainguinal revascularization from 2007 to 2009 was used to compare clinical outcomes, including overall survival (OS), major amputation (MA), major adverse limb event (MALE: repeat EVT, surgical reconstruction, or MA), and MALE-free survival after BSX vs. EVT using propensity score matching.
  
  
  RESULTS
  The median (interquartile range) follow-up duration after revascularization was 21 (8-33) months. The analysis of the 63 propensity score-matched pairs revealed no significant difference in OS (53% vs. 52%, P=0.96), MA (25% vs. 14%, P=0.71), MALE (42% vs. 58%, P=0.63), and MALE-free survival (33% vs. 11%, P=0.37) at 3 year after BSX vs. EVT.
  
  
  CONCLUSIONS
  In HD patients with CLI who underwent infrainguinal revascularization, OS, MA, MALE, and MALE-free survival rates were not significantly different after EVT vs. BSX. The less invasive EVT should be considered as the first-choice therapeutic strategy for HD patients with CLI.
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Shiraki
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center.
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.affiliation: Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Takahara
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Soga
authors.affiliation: Department of Vascular Surgery, Saiseikai Yahata General Hospital.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Mii
authors.affiliation: Department of Vascular Surgery, Kokura Memorial Hospital.
authors.forename: Jin
authors.initials: J
authors.lastname: Okazaki
authors.affiliation: Department of Vascular Surgery, Kokura Memorial Hospital.
authors.forename: Sosei
authors.initials: S
authors.lastname: Kuma
authors.affiliation: Department of Vascular Surgery, Matsuyama Red Cross Hospital.
authors.forename: Terutoshi
authors.initials: T
authors.lastname: Yamaoka
authors.affiliation: Department of Cardiology, Nagoya Kyoritsu Hospital.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kamoi
authors.affiliation: Department of Cardiology, Shin-Koga Hospital.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shintani
authors.affiliation: Department of Cardiology, Oita Oka Hospital.
authors.forename: Toshinobu
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Surgery, Shinsuma General Hospital.
authors.forename: Ikuro
authors.initials: I
authors.lastname: Kitano
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Uematsu
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D006348:Cardiac Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods*; D005121:Extremities / Q000098:blood supply; D005260:Female; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D007564:Japan; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000628:therapy*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
keywords: Bypass surgery; Critical limb ischemia; Endovascular therapy; Hemodialysis