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The Journal of Cardiovascular Surgery 2020 Dec 14

DOI: 10.23736/S0021-9509.20.11661-6


language: English

Early outcomes of patients with chronic kidney disease after revascularization for critical limb ischaemia

Asimakis GKREMOUTIS 1 , Theodosios BISDAS 2, Giovanni TORSELLO 3, Thomas SCHMITZ-RIXEN 4, Nikolaos TSILIMPARIS 5, Konstantinos STAVROULAKIS 3

1 Vascular Surgery, Royal Free Hospital, London, UK; 2 Department of Vascular and Endovascular Surgery, Athens Medical Center, Athens, Greece; 3 Department of Vascular Surgery, St. Franziskus Hospital Münster, Münster, Germany; 4 Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany; 5 Department of Vascular Surgery, Ludwig-Maximillians-University Hospital, Munich, Germany


BACKGROUND: To report early outcomes of patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) after revascularisation for critical limb-threatening ischemia (CLTI).
METHODS: Perioperative data of patients from the CRITISCH (CRITical limb ISCHaemia) registry, who also had NDD-CKD (stages 3 and 4), were compared to their counterparts with normal renal function (NRF) or mild renal insufficiency (stages 1 and 2). Patient characteristics and type of first-line treatment were assessed. Amputation-free survival was the primary composite endpoint. Secondary endpoints included major adverse cardiovascular and cerebral events (MACCE) and haemodynamic failure of revascularisation. Multivariable logistic regression determined risk factors for the endpoints.
RESULTS: 424 patients with NDD-CKD were identified. Endovascular revascularization (ER) was performed in 251 patients (59.2%). 86 patients (20.3%) underwent bypass surgery (BS) and 29 patients (6.8%) femoral artery patchplasty (FAP). Conservative treatment (CT) was offered to 46 patients (10.9%); 12 patients (2.8%) underwent primary major amputation (PMA). Logistic regression analysis showed an increased early risk for amputation/death (OR=1.92, 95% CI: 1.09-3.40), death (OR=5.53, 95% CI: 1.92-15.90) and haemodynamic failure of the revascularisation (OR=1.80, 95% CI: 1.19-2.72) compared to patients with NRF. Patients with NDD-CKD also seem to carry a higher risk for MACCE (OR: 1.82, 95% CI: 0.99-3.36). NDD-CKD was not a risk factor for limb loss alone (OR 1.05, 95% CI: 0.49-2.22).
CONCLUSIONS: NDD-CKD was an independent risk factor for early postoperative mortality, morbidity and reduced patency, but not for limb loss. Robust follow-up is necessary to monitor for such events, as well as to prevent readmission.

KEY WORDS: Limb-threatening ischaemia; Chronic kidney disease; Revascularization; Endovascular treatment; Bypass surgery

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