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. 2023 Sep:95:162-168.
doi: 10.1016/j.avsg.2023.05.002. Epub 2023 May 22.

Differences in Long-Term Outcomes in End-Stage Kidney Disease Patients with Chronic Limb-Threatening Ischemia

Stephanie L Rakestraw  1 , Zdenek Novak  1 , Michael Y Wang  1 , Charles A Banks  1 , Emily L Spangler  1 , Emily B Levitan  1 , Jayme E Locke  1 , Adam W Beck  1 , Danielle C Sutzko  2
Affiliations

Differences in Long-Term Outcomes in End-Stage Kidney Disease Patients with Chronic Limb-Threatening Ischemia

Stephanie L Rakestraw et al. Ann Vasc Surg. 2023 Sep.

Abstract

Background: End-stage kidney disease (ESKD) is a risk factor for peripheral arterial disease and major adverse limb events following infra-inguinal bypass. Despite comprising an important patient population, ESKD patients are rarely analyzed as a subgroup and are underrepresented in vascular surgery guidelines. This study aims to compare the long-term outcomes of patients with and without ESKD undergoing endovascular peripheral vascular intervention (PVI) for chronic limb-threatening ischemia (CLTI).

Methods: CLTI patients with and without ESKD from 2007-2020 were identified in the Vascular Quality Initiative PVI dataset. Patients with prior bilateral interventions were excluded. Patients undergoing femoral-popliteal and tibial interventions were included. Mortality, reintervention, amputation, and occlusion rates at 21 months following intervention were examined. Statistical analyses were completed with the t-test, chi-square, and Kaplan-Meier curves.

Results: The ESKD cohort was younger (66.4 ± 11.8 vs. 71.6 ± 12.1 years, P < 0.001) with higher rates of diabetes (82.2 vs. 60.9%, P < 0.001) the non-ESKD cohort. Long-term follow-up was available for 58.4% (N = 2,128 procedures) of ESKD patients and 60.8% (N = 13,075 procedures) of non-ESKD patients. At 21 months, ESKD patients had a higher mortality (41.7 vs. 17.4%, P < 0.001) and a higher amputation rate (22.3 vs. 7.1%, P < 0.001); however, they had a lower reintervention rate (13.2 vs. 24.6%, P < 0.001).

Conclusions: CLTI patients with ESKD have worse long-term outcomes at 2 years following PVI than non-ESKD patients. Mortality and amputation are higher with ESKD, while the reintervention rate is lower. Development of guidelines within the ESKD population has the potential to improve limb salvage.

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Figures

Fig. 1.
Fig. 1.
Patients and subgroups with and without ESKD undergoing tibial and nontibial intervention.
Fig. 2.
Fig. 2.
Kaplan Meier survival at 21 months following peripheral vascular intervention.
Fig. 3.
Fig. 3.
Kaplan Meier freedom from amputation at 21 months following peripheral vascular intervention.
Fig. 4.
Fig. 4.
Kaplan Meier freedom from occlusion at 21 months following peripheral vascular intervention.
Fig. 5.
Fig. 5.
Kaplan Meier freedom from reintervention at 21 months following peripheral vascular intervention.
See this image and copyright information in PMC

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