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

Stel VS, de Jong RW, Kramer A, Andrusev AM, Baltar JM, Barbullushi M, et al. Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe. Kidney Int 2021;100(1):182–95. Doi: 10.1016/j.kint.2020.12.010.

Arhuidese I, Nejim B, Locham S, Malas MB. Infrainguinal bypass surgery outcomes are worse in hemodialysis patients compared with patients with renal transplants. J Vasc Surg 2019;69(3):850–6. Doi: 10.1016/j.jvs.2018.05.252.

Cheng TW, Farber A, Kalish JA, King EG, Rybin D, Siracuse JJ. The Effect of Chronic and End-Stage Renal Disease on Long-Term Outcomes after Infrainguinal Bypass. Ann Vasc Surg 2023. Doi: 10.1016/j.avsg.2023.04.020.

Kodama A, Sugimoto M, Kuma S, Okazaki J, Mii S, Komori K. Clinical outcomes after infrainguinal bypass grafting for critical limb ischaemia in patients with dialysis-dependent end-stage renal failure. European Journal of Vascular and Endovascular Surgery 2014;48(6):695–702. Doi: 10.1016/j.ejvs.2014.08.022.

Conte MS, Bradbury AW, Kolh P, White J V., Dick F, Fitridge R, et al. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. European Journal of Vascular and Endovascular Surgery 2019;58(1):S1-S109.e33. Doi: 10.1016/j.ejvs.2019.05.006.

Soares TR, Cabral G, Costa T, Tiago J, Gimenez J, Duarte A, et al. Heparin-Bonded Expanded Polytetrafluoroethylene Is a Solution for Infrapopliteal Revascularization in the Absence of an Adequate Autologous Vein Graft. Ann Vasc Surg 2023. Doi: 10.1016/j.avsg.2023.06.015.

Cabral G, Soares T, Silva Costa T, Manuel Tiago J, Gimenez JL, Duarte A, et al. Ultra-distal revascularization in chronic limb threatening ischaemia: results are never out of fashion. Angiol Cir Vasc 2023;19(2). Doi: 10.48750/acv.485.

Mills JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, et al. The society for vascular surgery lower extremity threatened limb classification system: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg 2014;59(1):220--234.e2. Doi: 10.1016/j.jvs.2013.08.003.

Conte MS, Bradbury AW, Kolh P, White J V., Dick F, Fitridge R, et al. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. European Journal of Vascular and Endovascular Surgery 2019;58(1):S1-S109.e33. Doi: 10.1016/j. ejvs.2019.05.006.

Söderström M, Arvela E, Venermo M, Lepäntalo M, Albäck A. Tertiary patency as a measure of active revascularization policy for leg salvage. Ann Vasc Surg 2011;25(2):159–64. Doi: 10.1016/j.avsg.2010.07.018.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150(9):604–12. Doi: 10.7326/0003-4819-150-9-200905050-00006.

Dawson DB, Telles-Garcia NA, Atkins JL, Mina GS, Abreo AP, Virk CS, et al. End-stage renal disease patients undergoing angioplasty and bypass for critical limb ischemia have worse outcomes compared to non-ESRD patients: Systematic review and meta-analysis. Catheterization and Cardiovascular Interventions 2021;98(2):297–307. Doi: 10.1002/ccd.29688.

Lantis JC, Conte MS, Belkin M, Whittemore AD, Mannick JA, Donaldson MC. Infrainguinal bypass grafting in patients with end-stage renal disease: Improving outcomes? J Vasc Surg 2001;33(6):1171–8. Doi: 10.1067/mva.2001.115607.

Fitridge R, Chuter V, Mills J, Hinchliffe R, Azuma N, Behrendt C-A, et al. The Intersocietal IWGDF, ESVS, SVS Guidelines on Peripheral Artery Disease in People With Diabetes Mellitus and a Foot Ulcer. European Journal of Vascular and Endovascular Surgery 2023. Doi: 10.1016/j.ejvs.2023.07.020.

Georgopoulos S, Filis K, Vourliotakis G, Bakoyannis C, Papapetrou A, Klonaris C, et al. Lower extremity bypass procedures in diabetic patients with end-stage renal disease: Is it worthwhile? Nephron Clin Pract 2005;99(2). Doi: 10.1159/000082865.

Kumada Y, Nogaki H, Ishii H, Aoyama T, Kamoi D, Takahashi H, et al. Clinical outcome after infrapopliteal bypass surgery in chronic hemodialysis patients with critical limb ischemia. J Vasc Surg 2015;61(2):400–4. Doi: 10.1016/j.jvs.2014.09.007.

Cox MH, Robison JG, Brothers TE, Elliott BM, Carolina S. Contemporary Analysis of Outcomes following Lower Extremity Bypass in Patients with End-stage Renal Disease n.d. Doi: 10.1007/s10016O010067.

Söderström M, Arvela E, Albäck A, Aho PS, Lepäntalo M. Healing of Ischaemic Tissue Lesions after Infrainguinal Bypass Surgery for Critical Leg Ischaemia. European Journal of Vascular and Endovascular Surgery 2008;36(1):90–5. Doi: 10.1016/j. ejvs.2008.01.027.

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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 Jul. 2];31(1):33-9. Available from: https://pjctvs.com/index.php/journal/article/view/421

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