Related Experiment Video
Updated: Jul 23, 2026
Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
Published on: May 7, 2019
Long-term results justify autogenous infrainguinal bypass grafting in patients with end-stage renal failure
S L Meyerson1, C L Skelly, M A Curi
1Department of Surgery, Section of Vascular Surgery, University of Chicago, Ill., USA.
Insights
Infrainguinal bypass grafting in dialysis patients shows acceptable outcomes, particularly with autologous grafts. Limb salvage and survival rates exceed 50% at three years, challenging previous assumptions of poor results.
Area of Science:
- Vascular Surgery
- Nephrology
- End-Stage Renal Disease Management
Background:
- Infrainguinal bypass grafting for limb-threatening ischemia in end-stage renal disease (ESRD) patients is often perceived as high-risk with poor outcomes.
- This study investigates modern, long-term results of infrainguinal bypass grafting specifically in dialysis-dependent patients.
Purpose of the Study:
- To evaluate the safety and efficacy of infrainguinal bypass grafting in dialysis-dependent patients.
- To compare outcomes in dialysis-dependent patients versus those with functioning kidneys.
Main Methods:
- Retrospective analysis of 425 lower extremity revascularizations over 5 years at a single institution.
- Separate analysis of 82 limbs in 64 dialysis-dependent patients.
- Comparison of comorbidities, disease patterns, and surgical approaches between dialysis-dependent and non-dialysis patients.
Main Results:
- Dialysis patients had higher rates of diabetes, hypertension, and more distal vascular disease.
- Perioperative mortality (4.9%) and 3-year autogenous graft patency (67%) were comparable to non-dialysis patients.
- 3-year limb salvage (59%) and patient survival (60%) exceeded 50%, despite poorer outcomes with non-autogenous conduits.
Conclusions:
- Infrainguinal revascularization is a viable option for dialysis-dependent patients with limb-threatening ischemia.
- Acceptable perioperative and long-term results can be achieved, particularly when autologous conduits are utilized.
- Outcomes support challenging the traditional view of poor results for this patient population.
Introduction:
Infrainguinal bypass grafting for limb-threatening ischemia in patients with end-stage renal disease is generally thought to be associated with increased operative risk and poor long-term outcome. This retrospective study was undertaken to examine the modern-era, long-term results of infrainguinal bypass grafting in dialysis-dependent patients.
Methods:
Over the past 5 years in a single institution, 425 lower extremities (368 consecutive patients) were revascularized for the indication of limb salvage. Sixty-four patients (82 limbs) were dialysis-dependent at the time of revascularization, and this group was analyzed separately. They exhibited statistically significant higher incidences of diabetes (83% vs 56%; P <.001), hypertension (91% vs 74%; P <.001), and more distal vascular disease, which required a greater proportion of proximal anastomoses at the popliteal level (24% vs 11%; P <.01) and distal anastomoses at the infrapopliteal level (75% vs 65%; P <.05).
Results:
Despite the higher prevalence of comorbid conditions and distal disease in patients with renal failure, their perioperative 30-day mortality rate remained low (4.9%) and was not significantly different from that in patients with functioning kidneys (2.9%; P = not significant). After a median follow-up of 11 months (range, 0-60 months), the 3-year autogenous conduit secondary graft patency in patients with renal failure was no different than in patients with functioning kidneys (67% +/- 9% vs 64% +/- 5%; P = not significant). Nonautogenous conduits in dialysis-dependent patients exhibited a significantly poorer outcome with only 27% +/- 12% remaining secondarily patent at 2 years. As expected, both limb salvage and patient survival were significantly less in patients with renal faiture, although both exceeded 50% at 3 years (limb salvage 59% +/- 8% vs 68% +/- 5%; P <.05; patient survival 60% +/- 8% vs 86% +/- 4%; P <.001). The often-quoted phenomenon of limb loss, despite a patent bypass graft, occurred infrequently in this study (n = 3 of 82 limbs).
Conclusion:
Infrainguinal revascularization can be performed in dialysis-dependent patients with acceptable perioperative and long-term results, especially in patients in whom adequate autologous conduit is available.
