Is lower extremity revascularization worthwhile in patients with end-stage renal disease?

Area of Science:

• Vascular Surgery
• Nephrology
• Health Economics

Background:

• Patients with end-stage renal disease (ESRD) on dialysis often present with critical limb ischemia.
• Aggressive limb preservation strategies are employed, but outcomes and costs in this population require careful evaluation.

Purpose of the Study:

• To review outcomes of lower extremity revascularization in dialysis patients.
• To assess the functional benefit and cost-effectiveness of aggressive limb salvage in this high-risk group.

Main Methods:

• A retrospective review of 33 bypass operations on 31 limbs in 23 dialysis-dependent patients over 5 years.
• Procedures included aortobifemoral, femoropopliteal, and femorotibial/pedal bypasses.
• Analysis of graft patency, limb salvage, patient survival, and associated costs.

Main Results:

• Excellent 30-day primary graft patency (100%) and 2-year secondary patency (79%).
• Limb salvage rates at 1 and 2 years were 67% and 59%, respectively.
• Poor patient survival (47% at 2 years), with peritoneal dialysis and extensive tissue loss predicting worse outcomes.

Conclusions:

• Revascularization offers initial graft success but is hampered by poor patient survival and high costs in ESRD patients.
• A selective approach is recommended, considering primary amputation for patients on peritoneal dialysis or with extensive tissue loss.
• The high cost per year of limb salvage necessitates careful patient selection.