Infrainguinal endovascular and bypass surgery for critical leg ischemia in patients on long-term dialysis

Ann Vasc Surg. 2002 Mar;16(2):210-4. doi: 10.1007/s10016-001-0161-1. Epub 2002 Feb 20.


Lower limb revascularization has been shown to be worthwhile for treatment of critical leg ischemia in uremic patients, but poor results are expected in patients on long-term dialysis. We have retrospectively evaluated the results of a series of 21 consecutive patients on long-term dialysis who underwent 20 infrainguinal bypass graft and 5 endovascular procedures for critical leg ischemia to identify factors contraindicating any infrainguinal revascularization attempt in this patient population. At 2-year follow-up, the patency rate was 74%, leg salvage rate was 85%, and survival rate was 23%, whereas 23% of patients were alive with salvaged leg. Patients on hemodialysis achieved better survival outcome than patients on peritoneal dialysis (p = 0.02). Multivariate analysis showed that low serum level of albumin (p = 0.009; p = 0.005) and coronary artery disease (p = 0.0002; p = 0.001) had an adverse effect on the survival rate and on the rate of patients alive with salvaged leg, respectively. Patients without coronary artery disease achieved an alive-with-salvaged-leg rate at 1- and 2-year follow-up of 68% and 41%, respectively, whereas 12% of patients with coronary artery disease survived with salvaged leg after 1 year, but none of them survived with salvaged leg at 2-year follow-up (p = 0.003). In conclusion, infrainguinal revascularization for lower extremity ischemia in dialysis patients is hardly indicated in the presence of coronary artery disease and severe hypoalbuminemia.

MeSH terms

  • Adult
  • Aged
  • Coronary Artery Disease / mortality
  • Female
  • Femoral Artery / surgery
  • Humans
  • Ischemia / etiology
  • Ischemia / surgery*
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy
  • Leg / blood supply*
  • Limb Salvage / methods*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Popliteal Artery / surgery
  • Renal Dialysis
  • Risk Factors
  • Serum Albumin
  • Survival Rate
  • Vascular Patency
  • Vascular Surgical Procedures


  • Serum Albumin