Chronic kidney disease and outcomes of lower extremity revascularization for peripheral artery disease

Smilowitz, Nathaniel R.; Bhandari, Nipun; Berger, Jeffrey S.

doi:10.1016/j.atherosclerosis.2019.12.016

Cited by 33 publications

(27 citation statements)

References 25 publications

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“…6 Recent research indicates an increase in hospitalization and cardiovascular events in patients with PAD due to CKD. 39 In a recent report, elevated suPAR levels were linked to systemic atherosclerosis and an increased mortality risk. 8 This study mainly included patients suffering from coronary artery disease (CAD) (n = 3614) or CAD with additional PAD (n = 869) in comparison to 99 patients with PAD alone.…”

Section: Discussionmentioning

confidence: 98%

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Soluble urokinase-type plasminogen activator receptor predicts peripheral artery disease severity and outcomes

et al. 2021

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Soluble urokinase-type plasminogen activator receptor (suPAR) is associated with chronic kidney disease (CKD) severity and peripheral artery disease (PAD). We hypothesize an association of PAD severity and suPAR in patients without advanced CKD and further risk stratification according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. For study purposes, suPAR was measured in 334 PAD patients (34% women, age 69 (62–78) years, eGFR 68 ± 20 mL/min/1.72 m2) by commercial ELISA. Patients were followed for 10 years to assess long-term all-cause survival by Cox regression. Higher suPAR levels were associated with lower ankle–brachial index ( R = −0.215, p = 0.001) in patients with PAD without media-sclerosis ( n = 236). suPAR levels inversely correlated with decreased glomerular filtration rate ( R = −0.476, p < 0.001) and directly correlated with urinary albumin-to-creatinine ratio ( R = 0.207, p < 0.001). Furthermore, higher suPAR levels associated with a higher KDIGO risk score ( p < 0.001). Baseline suPAR was significantly associated with all-cause mortality (HR 1.40 (95% CI 1.16–1.68), p < 0.001) over 10 years. suPAR remained associated with mortality (HR 1.29 (1.03–1.61), p = 0.026) after multivariable adjustment for age, sex, cardiovascular risk factors, and eGFR. Future research may define a standard role for suPAR assessment in PAD’s work-up and treatment, especially in patients with CKD.

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Section: Discussionmentioning

confidence: 98%

“… 6 Recent research indicates an increase in hospitalization and cardiovascular events in patients with PAD due to CKD. 39 …”

Section: Discussionmentioning

confidence: 99%

Soluble urokinase-type plasminogen activator receptor predicts peripheral artery disease severity and outcomes

et al. 2021

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“…Moreover, renal impairment is an important predictor of poor outcomes [ 94 ]. In a recent analysis, Smilowitz et al examined a large representative national cohort from the United States undergoing surgical or endovascular revascularization for PAD with and without CKD or ESRD [ 102 ]. They found that CKD and ESRD were associated with a 74% increased risk of perioperative MACE in patients undergoing both endovascular and surgical lower extremity revascularization.…”

Section: The Unsolved Conundrum Of Controlling Risk Factorsmentioning

confidence: 99%

“…Lower extremity amputation occurred more frequently in patients with PAD and renal disease. Moreover, patients with renal disease required more hospital readmission within 6 months compared to those without renal disease [ 102 ]. In this analysis, the most common indications for hospital readmission were cardiovascular disease, endocrine/metabolic issues, and infectious complications.…”

Section: The Unsolved Conundrum Of Controlling Risk Factorsmentioning

confidence: 99%

Outcomes of Lower Extremity Endovascular Revascularization: Potential Predictors and Prevention Strategies

Biscetti

Nardella

Rando

et al. 2021

IJMS

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Peripheral artery disease (PAD) is a manifestation of atherosclerosis, which may affect arteries of the lower extremities. The most dangerous PAD complication is chronic limb-threatening ischemia (CLTI). Without revascularization, CLTI often causes limb loss. However, neither open surgical revascularization nor endovascular treatment (EVT) ensure long-term success and freedom from restenosis and revascularization failure. In recent years, EVT has gained growing acceptance among all vascular specialties, becoming the primary approach of revascularization in patients with CLTI. In clinical practice, different clinical outcomes after EVT in patients with similar comorbidities undergoing the same procedure (in terms of revascularization technique and localization of the disease) cause unsolved issues that need to be addressed. Nowadays, risk management of revascularization failure is one of the major challenges in the vascular field. The aim of this literature review is to identify potential predictors for lower extremity endovascular revascularization outcomes and possible prevention strategies.

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“…Although some risk factors of ISR after SFA stent placement have been extensively investigated such as age, diabetes mellitus, hemodialysis, and tibial runoff arteries, [8][9][10] there are relatively few data about the predictors for long-segment SFA lesions to guide clinical practice. Furthermore, most studies evaluate lesions with computed tomography angiography (CTA) or digital subtraction angiography (DSA).…”

Section: Introductionmentioning

confidence: 99%

Pre-procedural color duplex ultrasound evaluation predicts restenosis after long-segment superficial femoral artery stenting

Gao

Yang

et al. 2021

Vascular

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Objectives Restenosis after stenting for superficial femoral artery atherosclerotic disease remains a significant clinical problem, especially for long-segment lesions. We assessed predictors of in-stent restenosis in patients with long-segment superficial femoral artery disease and hypothesized that pre-procedural ultrasound assessment would predict in-stent restenosis. Methods This single-center study retrospectively analyzed 283 limbs in 243 patients who treated with superficial femoral artery nitinol stent placement for long-segment (≥15 cm) lesions between 2015 and 2018. Color duplex ultrasound was performed pre-procedure and post-procedure at 3, 6, 12, 24, and 36 months. The endpoint was ≥50% in-stent restenosis in the superficial femoral artery. Primary patency rates were analyzed with Kaplan–Meier survival analysis and compared using the log-rank test. A multivariable Cox proportional hazards model was used to evaluate the risk factors for in-stent restenosis. Results The median length of lesions was 25.8 ± 8.1 cm. The cumulative freedom from ≥50% in-stent restenosis at 3, 6, 12, 24, and 36 months was 95.3%, 78.3%, 56.0%, 30.6%, and 15.9%, respectively. Univariate and multivariate Cox regression analysis showed that cumulative lesion length ≥ 25 cm (hazard ratio 1.681; p = 0.003), calcified plaque (hazard ratio 1.549, p = 0.006), poor runoff scores >10 (hazard ratio 1.870, p = 0.003), and chronic renal failure (hazard ratio 2.075, p = 0.009) were independent risk factors for in-stent restenosis. The agreement rate between ultrasound and angiography was 92.6% for cumulative lesion length ( κ 0.851) and 91.9% for runoff score ( κ 0.872). Conclusions The results indicate that pre-procedural color duplex ultrasound evaluation is helpful for the selection of appropriate candidates for superficial femoral artery stent placement. Cumulative lesion length ≥25 cm, plaque calcification, poor distal runoff, and chronic renal failure independently predicted in-stent restenosis.

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Chronic kidney disease and outcomes of lower extremity revascularization for peripheral artery disease

Cited by 33 publications

References 25 publications

Soluble urokinase-type plasminogen activator receptor predicts peripheral artery disease severity and outcomes

Soluble urokinase-type plasminogen activator receptor predicts peripheral artery disease severity and outcomes

Outcomes of Lower Extremity Endovascular Revascularization: Potential Predictors and Prevention Strategies

Pre-procedural color duplex ultrasound evaluation predicts restenosis after long-segment superficial femoral artery stenting

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