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Long-Term Outcome of Lower Extremity Bypass Surgery in Patients with Chronic Kidney Disease and Critical Limb Ischemia in Germany.
Meyer, Philipp; Surmann, Johanna; Epple, Jasmin; Böckler, Dittmar; Schmitz-Rixen, Thomas; Grundmann, Reinhart T.
Afiliación
  • Meyer P; Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
  • Surmann J; Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
  • Epple J; Department of Vascular and Endovascular Surgery, Frankfurt University Hospital, Frankfurt, Germany.
  • Böckler D; Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
  • Schmitz-Rixen T; Department of Vascular and Endovascular Surgery, Goethe University, Frankfurt, Germany.
  • Grundmann RT; Department and Polyclinic for Vascular Medicine, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: grundmann@medsachverstand.de.
Ann Vasc Surg ; 108: 365-374, 2024 Nov.
Article en En | MEDLINE | ID: mdl-39009125
ABSTRACT

BACKGROUND:

The aim of this study is to present short- and long-term outcomes after lower extremity bypass (LEB) surgery in patients with chronic limb-threatening ischemia and chronic kidney disease (CKD), differentiated by peripheral artery disease (PAD) Fontaine stage III and IV.

METHODS:

Retrospective analysis of anonymized data from a nationwide German health insurance company (AOK). Data from 22,633 patients (14,523 men) who underwent LEB from 2010 to 2015 were analyzed, presenting 18,271 with CKD stage 1/2, 2,483 patients with CKD stage 3, and 1,879 with CKD stage 4/5.

RESULTS:

Perioperative mortality (60-day mortality) was 7.2% for CKD stage 1/2, 12.4% for CKD stage 3, and 19.8% for CKD stage 4/5. Patients with PAD stage IV had significantly higher perioperative mortality (10.3%) than patients with PAD stage III (4.5%). The perioperative major amputation rate depended significantly on PAD stage IV (odds ratio [OR] 2.57 confidence interval [CI] 2.16-3.05, P < 0.001), the LEB level below the knee and crural/pedal (OR 2.49 CI 2.14-2.90, P < 0.001), CKD stage 4/5 (OR 1.28, CI 1.06-1.54, P = 0.009), and the presence of diabetes mellitus type 2 (OR 1.19, CI 1.05-1.36, P = 0.007). Kaplan-Meier estimated long-term survival of up to 9 years after surgery was 31.7% for patients with CKD stage 1 and 2, 14.3% for CKD stage 3, and only 10.1% for CKD stage 4 and 5 (P < 0.001). PAD Fontaine stage IV versus III (hazard ratio 1.64, CI 1.56-1.71, P < 0.001), but not bypass level, had an independent adverse influence on long-term survival.

CONCLUSION:

CKD and PAD stage were equally significant independent predictors of patient survival and major adverse cardiovascular events with higher PAD and CKD stages associated with less favorable long-term outcomes.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad Crítica / Recuperación del Miembro / Extremidad Inferior / Insuficiencia Renal Crónica / Enfermedad Arterial Periférica / Amputación Quirúrgica Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Ann Vasc Surg Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Países Bajos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad Crítica / Recuperación del Miembro / Extremidad Inferior / Insuficiencia Renal Crónica / Enfermedad Arterial Periférica / Amputación Quirúrgica Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Ann Vasc Surg Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Países Bajos