Infrainguinal Revascularization in End-Stage Renal Disease

Lumsden, A.B.; Besman, Anatole; Jaffe, Murray S.; MacDonald, M. Julia; Allen, Robert C.

doi:10.1007/bf02133412

Cited by 46 publications

(22 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the surgical management of PVD in the dialysis population remains controversial. It has been suggested by some authors that because of delayed wound healing and prolonged hospitalization, primary amputation is preferred over revascularization for PVD in dialysis patients while others have argued that a careful selection of dialysis patients for revascularization might result in acceptable outcomes [5-12]. In this study, we examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a large cohort of Medicare dialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

et al. 2005

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Arterial reperfusion with the use of bypass grafts to pedal vessels represents an important advance in limb salvage procedures in the general population [4]. Despite significant advances in these procedures, the role of vascular reconstruction for severe PVD in the high-risk group of patients with ESRD has remained controversial [5][6][7][8][9]. Uncontrolled case series of lower extremity surgical revascularization for PVD in patients with ESRD have in general shown poor results compared to the general population [5,6,10] and this has led some authors to consider primary amputation for the treatment of severe lower extremity ischemia [5,6].…”

mentioning

confidence: 99%

Predictors of amputation and survival following lower extremity revascularization in hemodialysis patients

Jaar¹,

Astor²,

Berns³

et al. 2004

Kidney International

106

View full text Add to dashboard Cite

Risk of amputation following revascularization procedures was positively associated with type of procedure, black race, uninsured/Medicaid, and diabetes status. Risk of death was also higher following bypass. While this might reflect underlying severity of disease, patient education, screening, and optimal care of lower extremities should be emphasized to detect PVD at an early stage of the disease process.

show abstract

“…amputation or revascularization) is more prevalent among patients with renal insufficiency than in those with normal renal function (1)(2)(3). High serum creatinine is associated with poor long-term outcomes after lower extremity revascularization (4) and numerous small retrospective surgical series of revascularization in patients with advanced renal insufficiency have now shown that these patients are at increased risk for short-and long-term post-operative mortality and graft failure compared to patients with normal renal function (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

mentioning

confidence: 99%

Impact of Renal Insufficiency on Short-Term Morbidity and Mortality after Lower Extremity Revascularization

O’Hare¹,

Feinglass

Sidawy³

et al. 2003

Journal of the American Society of Nephrology

109

View full text Add to dashboard Cite

Abstract. Few data are available on the impact of renal insufficiency on short-term operative outcomes after lower extremity surgical revascularization. We used prospectively collected data from the Department of Veterans Affairs' National Surgical Quality Improvement Program (NSQIP) to explore the association with renal dysfunction of adverse outcomes occurring within 30 d of lower extremity surgical revascularization in a cohort of all patients undergoing at least one lower extremity surgical revascularization from 1/1/94 to 9/30/01 (n ϭ 18,217). Even moderate renal insufficiency (estimated GFR 30-59cc/min/1.73m2 ) was associated with an increased incidence of postoperative death (adjusted odds ratio (OR) 1.44, 95% confidence interval (CI), 1.17 to 1.77, P ϭ 0.001), cardiac arrest (OR 1.43, CI 1.09 to 1.88, P ϭ 0.011), myocardial infarction (OR 1.68, 1.39 to 2.16, P Ͻ 0.001), unplanned intubation (OR 1.69, CI 1.39 to 2.07, P Ͻ 0.001) and prolonged intubation (OR 1.57, CI 1.28 to 1.94, P Ͻ 0.001) within 30 d of lower extremity revascularization. However, the incidence of wound infection and graft failure requiring return to the operating room did not appear to be substantially higher in this group. Our data also show that patients with renal insufficiency undergoing revascularization were more likely to require distal procedures and to present with limb-threatening infection compared to those with normal renal function. Efforts to improve pre-and post-operative care in patients with renal insufficiency undergoing lower extremity revascularization should take into account the increased incidence of postoperative death and cardiopulmonary complications in this group in addition to more traditional concerns about operative site complications. Further studies are needed to explore reasons for the higher rate of limb-threatening infection in patients with renal insufficiency undergoing revascularization.Peripheral vascular disease requiring operative intervention (i.e. amputation or revascularization) is more prevalent among patients with renal insufficiency than in those with normal renal function (1-3). High serum creatinine is associated with poor long-term outcomes after lower extremity revascularization (4) and numerous small retrospective surgical series of revascularization in patients with advanced renal insufficiency have now shown that these patients are at increased risk for short-and long-term post-operative mortality and graft failure compared to patients with normal renal function (5-23).However, few data are available to patients, families and health care providers regarding the association of specific adverse outcomes for patients with renal insufficiency after lower extremity revascularization surgery. Large variations in patient characteristics (such as inclusion of patients not yet requiring dialysis or renal transplant patients), indications for surgery and nature of surgery performed exist between retrospective surgical series. Therefore, it has proven difficult to

show abstract

Infrainguinal Revascularization in End-Stage Renal Disease

Cited by 46 publications

References 12 publications

Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

Predictors of amputation and survival following lower extremity revascularization in hemodialysis patients

Impact of Renal Insufficiency on Short-Term Morbidity and Mortality after Lower Extremity Revascularization

Contact Info

Product

Resources

About