Long-Term Outcome of Lower Extremity Bypass Surgery in Patients with Chronic Kidney Disease and Critical Limb Ischemia in Germany.

Publisher: Elsevier Country of Publication: Netherlands NLM ID: 8703941 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1615-5947 (Electronic) Linking ISSN: 08905096 NLM ISO Abbreviation: Ann Vasc Surg Subsets: MEDLINE

Publication: <2007->: Netherlands : Elsevier
Original Publication: Detroit : [Published by Expansion scientifique française for Annals of Vascular Surgery, Inc. and Association pour la promotion de la chirurgie vasculaire, Paris, c1986-

Peripheral Arterial Disease*/surgery ; Peripheral Arterial Disease*/mortality ; Peripheral Arterial Disease*/diagnosis ; Renal Insufficiency, Chronic*/mortality ; Renal Insufficiency, Chronic*/complications ; Renal Insufficiency, Chronic*/diagnosis ; Amputation, Surgical* ; Lower Extremity*/blood supply ; Limb Salvage* ; Critical Illness*; Humans ; Male ; Female ; Germany ; Retrospective Studies ; Time Factors ; Aged ; Treatment Outcome ; Risk Factors ; Middle Aged ; Aged, 80 and over ; Risk Assessment ; Chronic Limb-Threatening Ischemia/surgery ; Chronic Limb-Threatening Ischemia/mortality ; Chronic Limb-Threatening Ischemia/complications ; Ischemia/surgery ; Ischemia/mortality ; Ischemia/diagnosis ; Databases, Factual ; Vascular Grafting/adverse effects ; Vascular Grafting/mortality ; Postoperative Complications/mortality ; Postoperative Complications/etiology

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.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Date Created: 20240715 Date Completed: 20240914 Latest Revision: 20240914

20240916

10.1016/j.avsg.2024.06.014

39009125