PMID- 37225013
OWN - NLM
STAT- MEDLINE
DCOM- 20230829
LR  - 20240329
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Print)
IS  - 0890-5096 (Linking)
VI  - 95
DP  - 2023 Sep
TI  - Differences in Long-Term Outcomes in End-Stage Kidney Disease Patients with 
      Chronic Limb-Threatening Ischemia.
PG  - 162-168
LID - S0890-5096(23)00260-1 [pii]
LID - 10.1016/j.avsg.2023.05.002 [doi]
AB  - 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.
CI  - Published by Elsevier Inc.
FAU - Rakestraw, Stephanie L
AU  - Rakestraw SL
AD  - Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
FAU - Novak, Zdenek
AU  - Novak Z
AD  - Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
FAU - Wang, Michael Y
AU  - Wang MY
AD  - Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
FAU - Banks, Charles A
AU  - Banks CA
AD  - Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
FAU - Spangler, Emily L
AU  - Spangler EL
AD  - Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
FAU - Levitan, Emily B
AU  - Levitan EB
AD  - Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
FAU - Locke, Jayme E
AU  - Locke JE
AD  - Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
FAU - Beck, Adam W
AU  - Beck AW
AD  - Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
FAU - Sutzko, Danielle C
AU  - Sutzko DC
AD  - Department of Surgery, University of Alabama at Birmingham, Birmingham, AL. 
      Electronic address: dsutzko@uabmc.edu.
LA  - eng
GR  - P30 DK079626/DK/NIDDK NIH HHS/United States
GR  - T32 DK007545/DK/NIDDK NIH HHS/United States
GR  - T35 DK116670/DK/NIDDK NIH HHS/United States
PT  - Journal Article
DEP - 20230522
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Humans
MH  - Chronic Limb-Threatening Ischemia
MH  - *Endovascular Procedures/adverse effects
MH  - Treatment Outcome
MH  - Ischemia/diagnostic imaging/surgery
MH  - *Kidney Failure, Chronic/diagnosis/therapy/etiology
PMC - PMC10799672
MID - NIHMS1950425
EDAT- 2023/05/25 01:07
MHDA- 2023/08/29 12:43
PMCR- 2024/09/01
CRDT- 2023/05/24 19:22
PHST- 2023/03/24 00:00 [received]
PHST- 2023/05/05 00:00 [revised]
PHST- 2023/05/07 00:00 [accepted]
PHST- 2024/09/01 00:00 [pmc-release]
PHST- 2023/08/29 12:43 [medline]
PHST- 2023/05/25 01:07 [pubmed]
PHST- 2023/05/24 19:22 [entrez]
AID - S0890-5096(23)00260-1 [pii]
AID - 10.1016/j.avsg.2023.05.002 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2023 Sep;95:162-168. doi: 10.1016/j.avsg.2023.05.002. Epub 2023 
      May 22.