Infrapopliteal Bypass In Patients On Dialysis: Patency And Survival

Authors

  • Armanda Duarte Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, Portugal https://orcid.org/0000-0003-2067-1437
  • Tony R. Soares Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, Portugal https://orcid.org/0000-0002-9344-6858
  • Gonçalo Cabral Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, Portugal https://orcid.org/0000-0001-7511-1598
  • Tiago Costa Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, Portugal https://orcid.org/0000-0002-4925-3223
  • José Tiago Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, Portugal https://orcid.org/0009-0008-9437-0753
  • José Gimenez Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, Portugal
  • Diogo Cunha e Sá Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, Portugal

DOI:

https://doi.org/10.48729/pjctvs.421

Keywords:

Chronic Limb Threatening Ischemia, End-Stage Renal Disease, Dialysis

Abstract

Introduction

Portugal has one of the highest prevalence of patients on a regular dialysis program.

This population has a higher incidence of peripheral arterial disease with higher rates of postoperative morbidity and mortality.

Our goal was to compare outcomes between dialysis and non-dialysis patients with chronic limb threatening ischemia (CLTI) submitted to infrapopliteal bypass.

Materials and Methods

A retrospective single-center study of infrapopliteal bypass for CLTI was performed between 2012 and 2019. Patients were divided in two groups based on dialysis status (group 1 incorporated patients on dialysis). Primary end point was 1-year freedom from CLTI. Secondary end points were limb-salvage, survival and primary (PP) and tertiary patency (TP) rates at 3 years of follow-up.

Results

A total of 352 infrapopliteal bypasses were performed in 310 patients with CLTI. Fourteen percent of the revascularizations were performed on dialysis patients (48/352). Median age was 73 years (interquartile range - IQR 15) and 74% (259/352) were male. Median follow-up was 26 months (IQR 42). Overall, 92% (325/352) had tissue loss and 44% (154/352) had some degree of infection.

The majority of revascularization procedures were performed with vein grafts (61%, 214/352).

The 30-day mortality was 4% (11/310), with no difference between groups (p = 0.627). Kaplan-Meier analysis showed no difference between groups regarding freedom from CLTI (76% vs. 79%; HR 0.96, CI 0.65–1.44, p=0.857), limb-salvage (70% vs. 82%; HR 1.40, CI 0.71–2.78, p=0.327) and survival (62% vs. 64%; HR 1.08, CI 0.60–1.94, p=0.799). PP rates were 39% in group 1 and 64% in group 2 (HR 1.71, CI 1.05–2.79, p=0.030). TP rates were not different between groups (57% and 78%; HR 1.79, CI 0.92–3.47, p=0.082).

Conclusion

Infrapopliteal bypass for CLTI, on dialysis patients, resulted in lower PP rates. No differences were observed in freedom from CLTI, TP, limb salvage and survival.

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References

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Published

13-05-2024

How to Cite

1.
Duarte A, Soares TR, Cabral G, Costa T, Tiago J, Gimenez J, Cunha e Sá D. Infrapopliteal Bypass In Patients On Dialysis: Patency And Survival. Rev Port Cir Cardiotorac Vasc [Internet]. 2024 May 13 [cited 2024 May 21];31(1):33-9. Available from: https://pjctvs.com/index.php/journal/article/view/421

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