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Updated: Aug 9, 2026
Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia
Published on: June 8, 2019
[Results of infrainguinal revascularization in patients with end-stage renal disease]
J P Chambon1, B Alarcon, H D N'Guyen
1Service de chirurgie adultes Ouest A, CHU de Lille, hôpital Claude-Huriez, France. jp-chambon@chru-lille.fr <jp-chambon@chru-lille.fr>
Insights
Bypass surgery in end-stage renal disease (ESRD) patients shows moderate limb salvage rates but high mortality. Careful patient selection, focusing on cardiac health and limb condition, is crucial for improving outcomes in these high-risk individuals.
Area of Science:
- Vascular Surgery
- Nephrology
- Cardiology
Context:
- End-stage renal disease (ESRD) presents significant challenges for peripheral revascularization.
- Patients with ESRD often have multiple comorbidities, increasing surgical risks.
Purpose:
- To evaluate the efficacy of bypass surgery in ESRD patients.
- To identify predictive factors for survival and limb salvage.
- To determine optimal bypass indications in this population.
Summary:
- This retrospective study analyzed 50 bypass procedures in 41 ESRD patients (Leriche and Fontaine stages II-IV).
- Perioperative mortality was 12%, with a 2-year cumulative survival of 42.9% and limb salvage of 77.2%.
- Myocardial events predicted survival, while runoff and bypass occlusion predicted limb salvage.
Impact:
- Revascularization is feasible in ESRD patients, but outcomes require careful consideration.
- Preoperative evaluation of cardiac risk, foot conditions, vein availability, and nutritional status is essential.
- Optimizing patient selection can potentially improve the success rates of bypass surgery in ESRD.
Objectives:
The aim of this retrospective study was to evaluate the efficacy of bypass in patients with endstage renal disease (ESRD) and to determine predictive factors and precise bypass indications.
Method:
Forty one patients with ESRD underwent 50 bypass, 6 limbs were stage II and 44 stage III or IV according to Leriche and Fontaine classification. Revascularisations procedures were 47 infrainguinal bypass and 3 miscellaneous. Median follow up was 17,0+/-15,7 months.
Results:
Perioperative mortality rate was 12% (n = 6). Morbidity was as follow : 1 perioperative major imputation and 8 secondary ones. There were 26 secondary death (12 from cardiac events), cumulative survival rate declined to 42,9+/-7,7% and limb salvage rate to 77,2+/-7,5% at 2 years. Primary and secondary potency rates were 53,5+/-10,4% and 70,6+/-10%. Quality of life was good in 28% of revascularised patients. Among risk factors, myocardial events showed a statistical significance in predicting survival, good runoff and bypass occlusion showed a statistical significance in predicting limb salvage.
Conclusion:
Revascularisation can be performed in ESRD patients. However to improve the results full evaluation of myocardial risks, skin lesions and infection of the feet, available autologous vein and nutritional status may be needed in those patients.
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