In-hospital outcomes in patients with critical limb ischemia and end-stage renal disease after revascularization
Alexander Meyer, Werner Lang, Matthias Borowski, Giovanni Torsello, Theodosios Bisdas, CRITISCH collaborators, Thomas Schmitz-Rixen, Asimakis Gkremoutis, Markus Steinbauer, Thomas Betz, Hans-Henning Eckstein, Alexander Zimmermann, Hubert Schelzig, Alexander Oberhuber, Hans-Joachim Florek, Björn May, Martin Storck, Barbara Weis-Müller, Christian Reinhold, Dittmar Böckler, Arend Billing, Daniel Brixner, Thomas Hupp, Joachim Gerß, Sebastian E Debus, Mathias Spohn, Holger Reinecke, Christian Schlensack, Konstantinos P Donas, Konstantinos Stavroulakis, Wojciech Klonek, Heiner Wenk, Matthias Trede, Ralf-Gerhard Ritter, Karl-Ludwig Schulte, Tobias Keck, Kai Balzer, Bernhard Mühling, Farzin Adili, Reinhardt Grundmann, Thomas Zeller, Alexander Meyer, Werner Lang, Matthias Borowski, Giovanni Torsello, Theodosios Bisdas, CRITISCH collaborators, Thomas Schmitz-Rixen, Asimakis Gkremoutis, Markus Steinbauer, Thomas Betz, Hans-Henning Eckstein, Alexander Zimmermann, Hubert Schelzig, Alexander Oberhuber, Hans-Joachim Florek, Björn May, Martin Storck, Barbara Weis-Müller, Christian Reinhold, Dittmar Böckler, Arend Billing, Daniel Brixner, Thomas Hupp, Joachim Gerß, Sebastian E Debus, Mathias Spohn, Holger Reinecke, Christian Schlensack, Konstantinos P Donas, Konstantinos Stavroulakis, Wojciech Klonek, Heiner Wenk, Matthias Trede, Ralf-Gerhard Ritter, Karl-Ludwig Schulte, Tobias Keck, Kai Balzer, Bernhard Mühling, Farzin Adili, Reinhardt Grundmann, Thomas Zeller
Abstract
Objective: Analysis of in-hospital outcomes in patients treated for critical limb ischemia (CLI) and end-stage renal disease (ESRD) compared to CLI patients with normal renal function.
Methods: A subgroup analysis of the German CRITISCH registry, a prospective multicenter registry, assessing the first-line treatment strategies in CLI patients in 27 vascular centers in Germany was performed. The study cohort was divided into ESRD patients (n = 102) and patients with normal renal function (n = 674; glomerular filtration rate >60/mL/min/1.73 m(2)). The following first-line treatment strategies were assessed: endovascular therapy (EVT), bypass surgery, patch plasty, and no vascular intervention (conservative treatment, primary amputation). Uni- and multivariate analyses were performed to identify differences between groups as to six end points: amputation or death (composite end point), amputation, death, hemodynamic failure, major adverse cardiac and cerebrovascular events, and reintervention.
Results: Differences between the ESRD and non-ESRD group were found regarding the applied first-line therapy (P = .016): The first-line treatment strategies in ESRD patients were EVT in 64% (n = 65), bypass surgery in 13% (n = 13), patch plasty in 11% (n = 11), and no vascular intervention in 13% (n = 13). In non-ESRD patients, EVT was applied in 48% (n = 326), bypass surgery in 27% (n = 185), patch plasty in 13% (n = 86), and no vascular intervention in 11% (n = 77). For ESRD patients, a noticeably increased risk of the composite end point (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.19-5.79; P = .017), amputation (OR, 3.14; 95% CI, 1.35-7.31; P = .008), and hemodynamic failure (OR, 2.19; 95% CI, 1.19-4.04; P = .012) was observed.
Conclusions: CLI patients on dialysis represent a challenging cohort prone to in-hospital death, amputation, and hemodynamic failure. Two-thirds of these high-risk patients are treated with EVT. Present data suggest that this modality is generally considered as the most favorable treatment option in this patient subgroup.
Trial registration: ClinicalTrials.gov NCT01877252.
Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
Source: PubMed