Infrainguinal bypass in patients with end-stage renal disease

Surgery. 1995 Mar;117(3):319-24. doi: 10.1016/s0039-6060(05)80208-9.

Abstract

Background: This study was undertaken to evaluate the outcome of infrainguinal arterial reconstruction in a high-risk subset of patients with end-stage renal disease.

Methods: We reviewed the medical records of 44 patients requiring maintenance dialysis and undergoing 57 infrainguinal bypass procedures for limb salvage from 1986 to 1992. These included 16 (28%) femoropopliteal and 41 (72%) tibial or pedal bypasses with autogenous (82%), prosthetic (12%), or composite (6%) graft materials. The principal indications for operation were ischemic ulceration or gangrene (79%) and rest pain (21%). Angiographic evaluation most frequently showed single-vessel runoff (56%). Risk factors included age (mean, 63 years), diabetes (75%), hypertension (93%), coronary artery disease (52%), smoking (39%), previous myocardial infarction (20%), and contralateral amputation (18%). Infection was present in 22 limbs (39%).

Results: Early (30-day) surgical morbidity rate was 39%, including wound breakdown (19%), graft thrombosis (9%), and major amputation (4%). Perioperative mortality rate was 9%. Cumulative primary graft patency rates were 71% and 63%, secondary patency rates were 80% and 66%, and limb salvage rates were 70% and 52% at 1 and 2 years, respectively. Limb loss correlated most highly with the presence of preoperative infection (p = 0.036; log-rank method). Patient survival rate was 52% at 2 years.

Conclusions: Life-table analysis confirms a poor life expectancy for this population but indicates that an acceptable level of limb salvage may be achieved with arterial reconstruction in properly selected patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arteries / surgery
  • Humans
  • In Vitro Techniques
  • Inguinal Canal / blood supply*
  • Ischemia / etiology
  • Ischemia / surgery*
  • Kidney Failure, Chronic / complications*
  • Leg / blood supply*
  • Life Tables
  • Male
  • Middle Aged
  • Postoperative Complications
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Vascular Patency