Comparison of Clinical Outcomes after Surgical and Endovascular Revascularization in Hemodialysis Patients with Critical Limb Ischemia

• Published in: Journal of Atherosclerosis and Thrombosis 2017/06/01, Vol.24(6), pp.621-629
• Main Authors: Shiraki, Tatsuya, Iida, Osamu, Takahara, Mitsuyoshi, Soga, Yoshimitsu, Mii, Shinsuke, Okazaki, Jin, Kuma, Sosei, Yamaoka, Terutoshi, Kamoi, Daisuke, Shintani, Yoshiaki, Ishikawa, Toshinobu, Kitano, Ikuro, Uematsu, Masaaki
• Format: Article
• Language: English
• Subjects: Aged; Amputation, Surgical; Bypass surgery; Cardiac Surgical Procedures; Critical limb ischemia; Endovascular Procedures - adverse effects; Endovascular Procedures - methods; Endovascular therapy; Extremities - blood supply; Female; Hemodialysis; Humans; Ischemia - therapy; Japan; Kaplan-Meier Estimate; Limb Salvage; Male; Middle Aged; Original; Peripheral Arterial Disease - therapy; Propensity Score; Proportional Hazards Models; Registries; Renal Dialysis; Retrospective Studies; Risk Assessment; Risk Factors; Stents; Treatment Outcome
• ISSN: 1340-3478; 1880-3873; 1880-3873
• DOI: 10.5551/jat.35915

Aim: The treatment strategy for hemodialysis (HD) patients with critical limb ischemia (CLI) has been clinically debatable. Here we compared clinical outcomes after bypass surgery (BSX) and after endovascular therapy (EVT) using propensity score matching.Methods: A retrospective multicenter database of 246 (68 BSX and 178 EVT) consecutive HD patients with CLI (79% with tissue loss) who underwent infrainguinal revascularization from 2007 to 2009 was used to compare clinical outcomes, including overall survival (OS), major amputation (MA), major adverse limb event (MALE: repeat EVT, surgical reconstruction, or MA), and MALE-free survival after BSX vs. EVT using propensity score matching.Results: The median (interquartile range) follow-up duration after revascularization was 21 (8–33) months. The analysis of the 63 propensity score-matched pairs revealed no significant difference in OS (53% vs. 52%, P=0.96), MA (25% vs. 14%, P=0.71), MALE (42% vs. 58%, P=0.63), and MALE-free survival (33% vs. 11%, P=0.37) at 3 year after BSX vs. EVT.Conclusions: In HD patients with CLI who underwent infrainguinal revascularization, OS, MA, MALE, and MALE-free survival rates were not significantly different after EVT vs. BSX. The less invasive EVT should be considered as the first-choice therapeutic strategy for HD patients with CLI.