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Comparative Study
. 2017 Jun 1;24(6):621-629.
doi: 10.5551/jat.35915. Epub 2016 Oct 13.

Comparison of Clinical Outcomes after Surgical and Endovascular Revascularization in Hemodialysis Patients with Critical Limb Ischemia

Tatsuya Shiraki  1 , Osamu Iida  1 , Mitsuyoshi Takahara  2 , Yoshimitsu Soga  3 , Shinsuke Mii  4 , Jin Okazaki  5 , Sosei Kuma  5 , Terutoshi Yamaoka  6 , Daisuke Kamoi  7 , Yoshiaki Shintani  8 , Toshinobu Ishikawa  9 , Ikuro Kitano  10 , Masaaki Uematsu  1
Affiliations
Comparative Study

Comparison of Clinical Outcomes after Surgical and Endovascular Revascularization in Hemodialysis Patients with Critical Limb Ischemia

Tatsuya Shiraki et al. J Atheroscler Thromb. .

Abstract

Aim: The treatment strategy for hemodialysis (HD) patients with critical limb ischemia (CLI) has been clinically debatable. Here we compared clinical outcomes after bypass surgery (BSX) and after endovascular therapy (EVT) using propensity score matching.

Methods: A retrospective multicenter database of 246 (68 BSX and 178 EVT) consecutive HD patients with CLI (79% with tissue loss) who underwent infrainguinal revascularization from 2007 to 2009 was used to compare clinical outcomes, including overall survival (OS), major amputation (MA), major adverse limb event (MALE: repeat EVT, surgical reconstruction, or MA), and MALE-free survival after BSX vs. EVT using propensity score matching.

Results: The median (interquartile range) follow-up duration after revascularization was 21 (8-33) months. The analysis of the 63 propensity score-matched pairs revealed no significant difference in OS (53% vs. 52%, P=0.96), MA (25% vs. 14%, P=0.71), MALE (42% vs. 58%, P=0.63), and MALE-free survival (33% vs. 11%, P=0.37) at 3 year after BSX vs. EVT.

Conclusions: In HD patients with CLI who underwent infrainguinal revascularization, OS, MA, MALE, and MALE-free survival rates were not significantly different after EVT vs. BSX. The less invasive EVT should be considered as the first-choice therapeutic strategy for HD patients with CLI.

Keywords: Bypass surgery; Critical limb ischemia; Endovascular therapy; Hemodialysis.

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Conflict of interest statement

There is no financial arrangement or other relationship that could be construed as a conflict of interest.

Figures

Fig. 1.
Fig. 1.
Distribution of propensity scores in both matched and unmatched cases with EVT and BSX
Fig. 2.
Fig. 2.
OS for the propensity-matched pairs
Fig. 3.
Fig. 3.
MA for the propensity-matched pairs
Fig. 4.
Fig. 4.
Freedom from MALE (major amputation, repeat endovascular, or surgical reconstruction) for the propensity-matched pairs
Fig. 5.
Fig. 5.
MALE (major amputation, repeat endovascular, or surgical reconstruction)-free survival for the propensity-matched pairs
See this image and copyright information in PMC

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