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Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
Hemodialysis patients have worse outcomes after infrageniculate revascularization procedures
Caitlin W Hicks1, Joseph K Canner2, Kevin Kirkland2
1Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Insights
Hemodialysis (HD) patients undergoing infragenicular endovascular procedures for limb salvage have worse outcomes. Endovascular treatment for these patients is not associated with improved limb salvage and may be an inappropriate use of resources.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Nephrology
Background:
- Hemodialysis (HD) is linked to poor outcomes in femoropopliteal revascularization.
- HD patients often present with isolated infragenicular disease, impacting graft patency.
- This study compares outcomes for HD vs. non-HD patients undergoing infragenicular bypass or endovascular intervention.
Purpose of the Study:
- To compare the outcomes of hemodialysis (HD) versus non-HD patients after infragenicular open lower extremity bypass (LEB) and endovascular peripheral vascular interventions (PVIs).
- To assess the impact of HD on primary patency, secondary patency, and major amputation rates in patients with chronic limb-threatening ischemia.
Main Methods:
- Analysis of data from the Society for Vascular Surgery Vascular Quality Initiative database (2008-2014).
- Inclusion of patients undergoing infragenicular LEB or PVI for rest pain or tissue loss.
- Univariable and multivariable analyses of 1-year primary patency, secondary patency, and major amputation outcomes for HD vs. non-HD groups, stratified by treatment approach.
Main Results:
- Among 1688 patients, HD patients had more tissue loss and comorbidities.
- For LEB, 1-year patency was similar, but major amputations were higher in HD patients (27% vs. 14%).
- For PVI, HD patients had lower patency and higher major amputations (27% vs. 10%). Multivariable analysis showed similar LEB outcomes but worse PVI outcomes for HD patients.
Conclusions:
- Hemodialysis is an independent predictor of poor outcomes after infragenicular endovascular revascularization for chronic limb-threatening ischemia.
- Endovascular interventions in HD patients do not improve limb salvage and may represent inefficient healthcare resource utilization.
- Open bypass surgery may offer comparable outcomes to endovascular interventions for HD patients undergoing infragenicular revascularization.
Background:
Hemodialysis (HD) has been shown to be an independent predictor of poor outcomes after femoropopliteal revascularization procedures in patients with chronic limb-threatening ischemia. However, HD patients tend to have isolated infrageniculate disease, an anatomic risk factor for inferior patency. We aimed to compare outcomes for HD versus non-HD patients after infrageniculate open lower extremity bypass (LEB) and endovascular peripheral vascular interventions (PVIs).
Methods:
Data from the Society for Vascular Surgery Vascular Quality Initiative database (2008-2014) were analyzed. All patients undergoing infrageniculate 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 versus non-HD patients stratified by treatment approach using both univariable and multivariable analyses.
Results:
A total of 1688 patients were included, including 348 patients undergoing LEB (HD = 44 versus non-HD = 304) and 1340 patients undergoing PVI (HD = 223 versus non-HD = 1117). Patients on HD more frequently underwent revascularization for tissue loss (89% versus 77%, P < 0.001) and had ≥2 comorbidities (91% versus 76%, P < 0.001). Among patients undergoing LEB, 1-y PP (66% versus 69%) and SP (71% versus 78%) were similar for HD versus non-HD (P ≥ 0.25) groups, but major amputations occurred more frequently in the HD group (27% versus 14%; P = 0.03). Among patients undergoing PVI, 1-y PP (70% versus 78%) and SP (82% versus 90%) were lower and the frequency of major amputations was higher (27% versus 10%) for HD patients (all, P ≤ 0.02). After correcting for baseline differences between the groups, outcomes were similar for HD versus non-HD patients undergoing LEB (P ≥ 0.21) but persistently worse for HD patients undergoing PVI (all, P ≤ 0.006).
Conclusions:
HD is an independent predictor of poor patency and higher risk of major amputation after infrageniculate endovascular revascularization procedures for the treatment of chronic limb-threatening 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.
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