A decade experience with infrainguinal revascularization in a dialysis-dependent patient population
Objective: Although previous series have reported outcomes of lower extremity (LE) revascularization in patients with end-stage renal disease, the issue of LE bypass for limb salvage in this group has not been resolved. We herein present the largest series to date of a 10-year single-institution exp...
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creator | Ramdev, Pranay Rayan, Sunil S. Sheahan, Malachi Hamdan, Allen D. LoGerfo, Frank W. Akbari, Cameron M. Campbell, David R. Pomposelli, Frank B. |
description | Objective: Although previous series have reported outcomes of lower extremity (LE) revascularization in patients with end-stage renal disease, the issue of LE bypass for limb salvage in this group has not been resolved. We herein present the largest series to date of a 10-year single-institution experience with LE bypass in patients with dialysis dependence.
Methods: With prospectively entered data from a university teaching hospital's vascular registry, we reviewed the records of all patients with dialysis dependence who underwent LE arterial bypass between January 1, 1990, and May 31, 1999.
Results: A total of 146 consecutive patients (177 limbs) underwent infrainguinal revascularization, of whom nearly all (92%) had diabetes and tissue loss (91%). The in-hospital mortality rate was 3% (five patients). The rates for perioperative congestive heart failure, myocardial infarction, arrhythmia, and wound infection were 2%, 3%, 5%, and 10%, respectively. The actuarial graft primary and secondary patency rates at 1 and 3 years were 84% and 85%, and 64% and 68%, respectively. The limb salvage rates were 80% and 80% at 1 and 3 years. The 1-year and 3-year cumulative survival rates were 60% and 18%, respectively. At 5 years, survival was poor with only 5% of the entire cohort of 146 patients still alive. Multivariate logistic regression analysis at 6 months identified age (odds ratio, 0.96, 0.91) and number of years on dialysis (odds ratio, 0.79, 0.74) as significant (
P < .05) negative predictors of both limb salvage and survival, respectively.
Conclusion: Infrainguinal arterial reconstruction can be performed on patients with dialysis dependence with acceptable rates of limb salvage given the high incidence rate of perioperative complications and poor longevity of this patient group. Advanced age and number of years on dialysis seem to correlate with poorer outcome. (J Vasc Surg 2002;36:969-74.) |
doi_str_mv | 10.1067/mva.2002.128297 |
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Methods: With prospectively entered data from a university teaching hospital's vascular registry, we reviewed the records of all patients with dialysis dependence who underwent LE arterial bypass between January 1, 1990, and May 31, 1999.
Results: A total of 146 consecutive patients (177 limbs) underwent infrainguinal revascularization, of whom nearly all (92%) had diabetes and tissue loss (91%). The in-hospital mortality rate was 3% (five patients). The rates for perioperative congestive heart failure, myocardial infarction, arrhythmia, and wound infection were 2%, 3%, 5%, and 10%, respectively. The actuarial graft primary and secondary patency rates at 1 and 3 years were 84% and 85%, and 64% and 68%, respectively. The limb salvage rates were 80% and 80% at 1 and 3 years. The 1-year and 3-year cumulative survival rates were 60% and 18%, respectively. At 5 years, survival was poor with only 5% of the entire cohort of 146 patients still alive. Multivariate logistic regression analysis at 6 months identified age (odds ratio, 0.96, 0.91) and number of years on dialysis (odds ratio, 0.79, 0.74) as significant (
P < .05) negative predictors of both limb salvage and survival, respectively.
Conclusion: Infrainguinal arterial reconstruction can be performed on patients with dialysis dependence with acceptable rates of limb salvage given the high incidence rate of perioperative complications and poor longevity of this patient group. Advanced age and number of years on dialysis seem to correlate with poorer outcome. (J Vasc Surg 2002;36:969-74.)</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1067/mva.2002.128297</identifier><identifier>PMID: 12422107</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Biological and medical sciences ; Female ; Humans ; Kidney Failure, Chronic - physiopathology ; Kidney Failure, Chronic - therapy ; Leg - blood supply ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Peripheral Vascular Diseases - physiopathology ; Peripheral Vascular Diseases - surgery ; Registries - statistics & numerical data ; Renal Dialysis ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Survival Rate ; Vascular Surgical Procedures - mortality</subject><ispartof>Journal of vascular surgery, 2002-11, Vol.36 (5), p.969-974</ispartof><rights>2002 The Society for Vascular Surgery and The American Association for Vascular Surgery</rights><rights>2003 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-31073dcab590384446045a5556abc460b0c6197bb11188c698e966f3de3187ef3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1067/mva.2002.128297$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14020675$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12422107$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ramdev, Pranay</creatorcontrib><creatorcontrib>Rayan, Sunil S.</creatorcontrib><creatorcontrib>Sheahan, Malachi</creatorcontrib><creatorcontrib>Hamdan, Allen D.</creatorcontrib><creatorcontrib>LoGerfo, Frank W.</creatorcontrib><creatorcontrib>Akbari, Cameron M.</creatorcontrib><creatorcontrib>Campbell, David R.</creatorcontrib><creatorcontrib>Pomposelli, Frank B.</creatorcontrib><title>A decade experience with infrainguinal revascularization in a dialysis-dependent patient population</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Objective: Although previous series have reported outcomes of lower extremity (LE) revascularization in patients with end-stage renal disease, the issue of LE bypass for limb salvage in this group has not been resolved. We herein present the largest series to date of a 10-year single-institution experience with LE bypass in patients with dialysis dependence.
Methods: With prospectively entered data from a university teaching hospital's vascular registry, we reviewed the records of all patients with dialysis dependence who underwent LE arterial bypass between January 1, 1990, and May 31, 1999.
Results: A total of 146 consecutive patients (177 limbs) underwent infrainguinal revascularization, of whom nearly all (92%) had diabetes and tissue loss (91%). The in-hospital mortality rate was 3% (five patients). The rates for perioperative congestive heart failure, myocardial infarction, arrhythmia, and wound infection were 2%, 3%, 5%, and 10%, respectively. The actuarial graft primary and secondary patency rates at 1 and 3 years were 84% and 85%, and 64% and 68%, respectively. The limb salvage rates were 80% and 80% at 1 and 3 years. The 1-year and 3-year cumulative survival rates were 60% and 18%, respectively. At 5 years, survival was poor with only 5% of the entire cohort of 146 patients still alive. Multivariate logistic regression analysis at 6 months identified age (odds ratio, 0.96, 0.91) and number of years on dialysis (odds ratio, 0.79, 0.74) as significant (
P < .05) negative predictors of both limb salvage and survival, respectively.
Conclusion: Infrainguinal arterial reconstruction can be performed on patients with dialysis dependence with acceptable rates of limb salvage given the high incidence rate of perioperative complications and poor longevity of this patient group. Advanced age and number of years on dialysis seem to correlate with poorer outcome. (J Vasc Surg 2002;36:969-74.)</description><subject>Biological and medical sciences</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - physiopathology</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Leg - blood supply</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Peripheral Vascular Diseases - physiopathology</subject><subject>Peripheral Vascular Diseases - surgery</subject><subject>Registries - statistics & numerical data</subject><subject>Renal Dialysis</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Survival Rate</subject><subject>Vascular Surgical Procedures - mortality</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1LxDAQhoMoun6cvUkveuuaSdOkPYr4BYIXPYc0mWqkm9akXV1_vVl3wZOnl2GeeRkeQk6BzoEKeblY6jmjlM2BVayWO2QGtJa5qGi9S2ZUcshLBvyAHMb4TilAWcl9cgCMMwZUzoi5yiwabTHDrwGDQ28w-3TjW-Z8G7Tzr5PzussCLnU0U6eD-9aj633aZzqzTner6GJucUBv0Y_ZkNa_2Q8JX6PHZK_VXcSTbR6Rl9ub5-v7_PHp7uH66jE3HPiYF-mhwhrdlDUtKs65oLzUZVkK3Zg0NNQIqGXTAEBVGVFXWAvRFhYLqCS2xRG52PQOof-YMI5q4aLBrtMe-ykqyYTkHGgCLzegCX2MAVs1BLfQYaWAqrVXlbyqtVe18ZouzrbVU7NA-8dvRSbgfAskTbpL6rxx8Y_jlKXeMnH1hsMkYukwqGh-pVsX0IzK9u7fJ34A5MKUjw</recordid><startdate>20021101</startdate><enddate>20021101</enddate><creator>Ramdev, Pranay</creator><creator>Rayan, Sunil S.</creator><creator>Sheahan, Malachi</creator><creator>Hamdan, Allen D.</creator><creator>LoGerfo, Frank W.</creator><creator>Akbari, Cameron M.</creator><creator>Campbell, David R.</creator><creator>Pomposelli, Frank B.</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20021101</creationdate><title>A decade experience with infrainguinal revascularization in a dialysis-dependent patient population</title><author>Ramdev, Pranay ; Rayan, Sunil S. ; Sheahan, Malachi ; Hamdan, Allen D. ; LoGerfo, Frank W. ; Akbari, Cameron M. ; Campbell, David R. ; Pomposelli, Frank B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-31073dcab590384446045a5556abc460b0c6197bb11188c698e966f3de3187ef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Biological and medical sciences</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney Failure, Chronic - physiopathology</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Leg - blood supply</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Peripheral Vascular Diseases - physiopathology</topic><topic>Peripheral Vascular Diseases - surgery</topic><topic>Registries - statistics & numerical data</topic><topic>Renal Dialysis</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Survival Rate</topic><topic>Vascular Surgical Procedures - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ramdev, Pranay</creatorcontrib><creatorcontrib>Rayan, Sunil S.</creatorcontrib><creatorcontrib>Sheahan, Malachi</creatorcontrib><creatorcontrib>Hamdan, Allen D.</creatorcontrib><creatorcontrib>LoGerfo, Frank W.</creatorcontrib><creatorcontrib>Akbari, Cameron M.</creatorcontrib><creatorcontrib>Campbell, David R.</creatorcontrib><creatorcontrib>Pomposelli, Frank B.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ramdev, Pranay</au><au>Rayan, Sunil S.</au><au>Sheahan, Malachi</au><au>Hamdan, Allen D.</au><au>LoGerfo, Frank W.</au><au>Akbari, Cameron M.</au><au>Campbell, David R.</au><au>Pomposelli, Frank B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A decade experience with infrainguinal revascularization in a dialysis-dependent patient population</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2002-11-01</date><risdate>2002</risdate><volume>36</volume><issue>5</issue><spage>969</spage><epage>974</epage><pages>969-974</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Objective: Although previous series have reported outcomes of lower extremity (LE) revascularization in patients with end-stage renal disease, the issue of LE bypass for limb salvage in this group has not been resolved. We herein present the largest series to date of a 10-year single-institution experience with LE bypass in patients with dialysis dependence.
Methods: With prospectively entered data from a university teaching hospital's vascular registry, we reviewed the records of all patients with dialysis dependence who underwent LE arterial bypass between January 1, 1990, and May 31, 1999.
Results: A total of 146 consecutive patients (177 limbs) underwent infrainguinal revascularization, of whom nearly all (92%) had diabetes and tissue loss (91%). The in-hospital mortality rate was 3% (five patients). The rates for perioperative congestive heart failure, myocardial infarction, arrhythmia, and wound infection were 2%, 3%, 5%, and 10%, respectively. The actuarial graft primary and secondary patency rates at 1 and 3 years were 84% and 85%, and 64% and 68%, respectively. The limb salvage rates were 80% and 80% at 1 and 3 years. The 1-year and 3-year cumulative survival rates were 60% and 18%, respectively. At 5 years, survival was poor with only 5% of the entire cohort of 146 patients still alive. Multivariate logistic regression analysis at 6 months identified age (odds ratio, 0.96, 0.91) and number of years on dialysis (odds ratio, 0.79, 0.74) as significant (
P < .05) negative predictors of both limb salvage and survival, respectively.
Conclusion: Infrainguinal arterial reconstruction can be performed on patients with dialysis dependence with acceptable rates of limb salvage given the high incidence rate of perioperative complications and poor longevity of this patient group. Advanced age and number of years on dialysis seem to correlate with poorer outcome. (J Vasc Surg 2002;36:969-74.)</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>12422107</pmid><doi>10.1067/mva.2002.128297</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Biological and medical sciences Female Humans Kidney Failure, Chronic - physiopathology Kidney Failure, Chronic - therapy Leg - blood supply Logistic Models Male Medical sciences Middle Aged Peripheral Vascular Diseases - physiopathology Peripheral Vascular Diseases - surgery Registries - statistics & numerical data Renal Dialysis Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Rate Vascular Surgical Procedures - mortality |
title | A decade experience with infrainguinal revascularization in a dialysis-dependent patient population |
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