L. A. Huntress1, J. Kalenik2, V. Dombrovskiy1, S. G. Huang1, R. Shafritz1, S. Rahimi1 1Rutgers RWJMS,Division Of Vascular Surgery,New Brunswick, NJ, USA 2University of Georgia,Athens, GA, USA
Introduction: Femoral endarterectomy has proven to be a durable vascular reconstructive procedure for patients with critical limb ischemia (CLI). Our objective was to evaluate its applicability in patients with chronic renal failure that have severe claudication.
Methods: Patients 18 years or older with severe claudication who underwent femoral endarterectomy were selected from the 2012-2015 National Inpatient Sample using the appropriate ICD-9 and ICD-10 diagnosis and procedure codes. Postoperative outcomes in those with and without renal failure were compared using the Chi square test, multivariable logistic regression analysis, and Wilcoxon rank sum test. Patients with acute renal failure were excluded from the analysis
Results: Among the 30,805 patients in the study population, 2,705 (8.8%) had chronic renal failure. The likelihood of this comorbid disease was greater in older patients (70 years or older) compared to younger counterparts (OR [odds ratio]=1.74; 95%CI [confidence interval] 1.61-1.88), greater in females as compared to males (OR=1.22; 95%CI 1.12-1.33), and greater in Blacks as compared to Whites (OR=1.96; 95%CI 1.73-2.22). In the multivariable logistic regression analysis with control for age, gender, race, and comorbidities, chronic renal failure did not affect the rates of cardiac and respiratory complications, postoperative stroke, sepsis, or embolism/thrombosis of lower extremity arteries. No patient with chronic renal failure who underwent femoral endarterectomy required a major amputation as a complication of the procedure. However, patients with renal failure were more likely to develop bleeding (OR=1.35; 95%CI 1.20-1.51), or require blood transfusions (OR=1.89; 95%CI 1.69-2.13). Multivariable analysis showed equivalence in all cause hospital mortality between two groups. However, patients with chronic renal failure had longer hospital length of stay (median= 3 days, IQR [interquartile range] 2-4 days vs median= 2 days, IQR 1-3 days; P<0.0001) and greater total hospital cost (median= $14,235; IQR $9,621-20.878 vs median= $12,810; IQR $8,824-18,953; P<0.0001) compared to patients with normal renal function.
Conclusion: Femoral endarterectomy is a safe procedure in severe claudicants with chronic renal failure, but is associated with greater hospital resource utilization. Because of greater hospital LOS and increased bleeding complications, femoral endarterectomy in patients with chronic renal failure and claudication should be offered with caution.