In-hospital outcomes in patients with critical limb ischemia and end-stage renal disease after revascularization

Meyer A, Lang W, Borowski M, Torsello G, Bisdas T (2016)

Publication Type: Journal article

Publication year: 2016

Journal

Journal of Vascular Surgery Elsevier

Book Volume: 63

Pages Range: 966-73

Journal Issue: 4

DOI: 10.1016/j.jvs.2015.10.009

Abstract

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.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.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.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 with CRIS profile

Werner Lang Department of Vascular Surgery

Involved external institutions

Westfälische Wilhelms-Universität (WWU) Münster DE Germany (DE) Universitätsklinikum Münster DE Germany (DE)

How to cite

APA:

Meyer, A., Lang, W., Borowski, M., Torsello, G., & Bisdas, T. (2016). In-hospital outcomes in patients with critical limb ischemia and end-stage renal disease after revascularization. Journal of Vascular Surgery, 63(4), 966-73. https://doi.org/10.1016/j.jvs.2015.10.009

MLA:

Meyer, Alexander, et al. "In-hospital outcomes in patients with critical limb ischemia and end-stage renal disease after revascularization." Journal of Vascular Surgery 63.4 (2016): 966-73.

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