C. W. Hicks1, J. K. Canner2, K. Kirkland2, M. B. Malas1, J. H. Black1, C. J. Abularrage1 1Johns Hopkins University School Of Medicine,Division Of Vascular Surgery,Baltimore, MD, USA 2Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research,Baltimore, MD, USA
Introduction:
Hemodialysis (HD) has been shown to be an independent predictor of poor outcomes after femoropopliteal revascularization procedures in patients with critical limb ischemia (CLI). However, HD patients tend to have isolated infrapopliteal disease. We aimed to compare outcomes for HD versus non-HD patients following infrapopliteal open lower extremity bypass (LEB) and endovascular peripheral vascular interventions (PVI).
Methods:
Data from the Society for Vascular Surgery Vascular Quality Initiative database (2008-2014) were analyzed. All patients undergoing infrapopliteal LEB or PVI for rest pain or tissue loss were included. One-year primary patency (PP), secondary patency (SP), and major amputation outcomes were analyzed for HD vs. non-HD stratified by treatment approach using both univariable and multivariable analyses.
Results:
1,688 patients were included, including 348 patients undergoing LEB (HD=44 vs. non-HD=304) and 1,340 patients undergoing PVI (HD=223 vs. non-HD=1,117). Patients on HD more frequently underwent revascularization for tissue loss (89% vs. 77%, P<0.001) and had ≥2 comorbidities (91% vs. 76%, P<0.001). Among patients undergoing LEB, one-year PP (66% vs. 69%) and SP (71% vs. 78%) were similar for HD vs. non-HD (P≥0.25), but major amputations occurred more frequently in the HD group (27% vs. 14%; P=0.03). Among patients undergoing PVI, one-year PP (70% vs. 78%) and SP (82% vs. 90%) were lower and the frequency of major amputations was higher (27% vs. 10%; P<0.001) for HD patients (all, P<0.001). After correcting for baseline differences between groups, outcomes were similar for HD vs. non-HD patients undergoing LEB (P≥0.21), but persistently worse for HD patients undergoing PVI (all, P≤0.007) (Table).
Conclusion:
Hemodialysis is an independent predictor of poor patency and a higher risk of major amputation following infrapopliteal endovascular revascularization procedures for the treatment of critical limb ischemia. The use of endovascular interventions in these higher-risk patients is not associated with improved limb salvage outcomes and may be an inappropriate use of healthcare resources.
