Racial disparities after infrainguinal bypass surgery in hemodialysis patients

Arhuidese, Isibor; Wang, Xin Wei; Locham, Satinderjit; Faateh, Muhammad; Nejim, Besma

doi:10.1016/j.jvs.2017.04.044

Cited by 23 publications

(12 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regional variation has been shown to contribute to perioperative outcome disparities seen between black and white patients in the VQI. 20 Black and Hispanic patients have been more likely to have limb loss and less likely to maintain bypass patency; 4–9 with increased rates of limb loss persisting in black patients even when socioeconomic status was matched to white counterparts 21 though black and Hispanic patients have been shown to have lower rates of long-term mortality in comparison to white counterparts. 20,22 Amid the known superior patency of vein grafts compared to prosthetic conduit in IIB, 10 vein conduit utilization if feasible and of adequate size is an element of optimal care.…”

Section: Discussionmentioning

confidence: 99%

“…3 Racial disparities with regard to outcomes following IIB have previously been noted, with black and Hispanic patients more likely to have limb loss and less likely to maintain bypass patency. [4][5][6][7][8][9] Vein grafts have superior patency compared to prosthetic conduit for IIB. 10 The choice of conduit use (vein versus prosthetic) is often made at a surgeon level due to existing patient factors (such as anatomy and prior intervention history) and it is unknown whether there is an association of race with conduit choice.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Examination of race and infrainguinal bypass conduit use in the Society for Vascular Surgery Vascular Quality Initiative

et al. 2020

View full text Add to dashboard Cite

Background Vein conduit is known to have better patency than prosthetic for infrainguinal bypass. Here we explore if racial disparities exist in infrainguinal bypass vein conduit use amid preoperative patient and systemic factors. Methods Retrospective Society for Vascular Surgery Vascular Quality Initiative data for 23,959 infrainguinal bypasses between 2003 and 2017 for occlusive disease were analyzed. For homogeneity, only infrainguinal bypasses originating from the common femoral artery were included. Demographics of patients receiving vein vs prosthetic were compared and logistic regression analyses were performed with race and preoperative factors to evaluate for predictors of vein conduit use. Results Adjusted regression models demonstrated black patients were 76% as likely ( p < .001) and Hispanic patients 79% as likely ( p = .003) to have vein conduit compared to white patients. Factors positively correlating with vein use included vein mapping, more distal bypass target, tissue loss or acute ischemia bypass indications, commercial insurance, and weight. Factors against vein use included advanced age, female gender, ASA class 4, urgent procedure, preoperative mobility limitation, prior CABG or leg bypass, prior smoking, preoperative anticoagulation, and a bypass performed in the Southern US or before 2012. While black and Hispanic patients were less likely to receive vein, they were vein mapped at similar or higher rates than other groups. Conclusion Racial disparities exist in conduit use for infrainguinal bypass, with black and Hispanic patients less likely to receive vein bypasses. However, the contribution of race to conduit selection is small in adjusted and unadjusted models. Overall, pre-operative variables in the Vascular Quality Initiative poorly predicted vein conduit use for infrainguinal bypass.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Examination of race and infrainguinal bypass conduit use in the Society for Vascular Surgery Vascular Quality Initiative

et al. 2020

View full text Add to dashboard Cite

show abstract

“…20 The current study revealed higher loss of graft patency and limb loss among black women compared with white women, thus attracting the need to explore the practice-and tissue-level drivers of gender and racial disparities in outcomes. 21 Most of the limitations of our study are inherent to retrospective design and use of an administrative database. We cannot account for severity of disease, medication use, vein type or size, and prior or concurrent endovascular interventions.…”

Section: Discussionmentioning

confidence: 99%

Sex-based outcomes of lower extremity bypass surgery in hemodialysis patients

Arhuidese

Kernodle

Nejim

et al. 2018

Journal of Vascular Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…While a number of studies have demonstrated poor outcomes of lower extremity revascularization in patients with ESRD, little is known about results in patients with renal transplants . Previous reports have involved small cohorts and have often grouped together transplant and dialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Aggressive infrainguinal revascularization in renal transplant patients is justifiable

Craig‐Schapiro

Nejim

Arhuidese

2018

American Journal of Transplantation

Self Cite

View full text Add to dashboard Cite

While studies demonstrate poor outcomes of lower extremity revascularization in patients with end-stage renal disease, little is known about results in renal transplant patients. We analyzed 2-year primary patency and limb salvage outcomes and associated risk factors of transplant (n = 202) and nontransplant patients (n = 25 274) in the Vascular Quality Initiative database undergoing infrainguinal bypass from 2003 to 2016. Multivariable Cox regression analysis and coarsened exact matching with many-to-one were used. Transplant patients were more likely to have critical limb ischemia and revascularization of more distal arteries and to receive vein conduits. Primary patency was similar between transplant and nontransplant patients at 1 year (80.8% vs 77.5%) and 2 years (67.9% vs 63.7%, P = .079). Amputation-free survival was higher for nontransplant patients (1 year: 82.4% vs 75.3%, 2 years: 68.8% vs 58.2%, P = .0060), although overall survival was equivalent (2 years: 84.6% vs 87.2%, 4 years: 75.9% vs 79.6%, P = .35). Risk factors for primary patency loss included being female, critical limb ischemia, prior bypass, and distal bypass. Age, diabetes, prior contralateral amputation, critical limb ischemia, prosthetic conduit, and more distal bypass were associated with limb loss. This is the largest series of infrainguinal revascularization in transplant patients. Outcomes for transplant patients are not inferior, and aggressive approaches at limb salvage are justifiable in appropriately selected patients.

show abstract

Racial disparities after infrainguinal bypass surgery in hemodialysis patients

Cited by 23 publications

References 39 publications

Examination of race and infrainguinal bypass conduit use in the Society for Vascular Surgery Vascular Quality Initiative

Examination of race and infrainguinal bypass conduit use in the Society for Vascular Surgery Vascular Quality Initiative

Sex-based outcomes of lower extremity bypass surgery in hemodialysis patients

Aggressive infrainguinal revascularization in renal transplant patients is justifiable

Contact Info

Product

Resources

About