Infrapopliteal Bypass In Patients On Dialysis: Patency And Survival

Area of Science:

• Vascular Surgery
• Nephrology
• Cardiovascular Medicine

Background:

• Portugal exhibits a high prevalence of patients requiring regular dialysis.
• Dialysis patients have an increased incidence of peripheral arterial disease, leading to higher risks of postoperative complications.
• Chronic limb-threatening ischemia (CLTI) poses significant challenges in this patient population.

Purpose of the Study:

• To compare the outcomes of infrapopliteal bypass surgery for CLTI between patients on regular dialysis and those not on dialysis.
• To evaluate differences in key clinical endpoints, including limb salvage, survival, and graft patency.

Main Methods:

• A retrospective single-center study included 310 patients with CLTI undergoing infrapopliteal bypass between 2012 and 2019.
• Patients were categorized into two groups: those on dialysis and those not on dialysis.
• Outcomes assessed included 1-year freedom from CLTI, 3-year limb-salvage, survival, primary patency (PP), and tertiary patency (TP).

Main Results:

• A total of 352 bypass procedures were analyzed, with 14% performed on dialysis patients.
• No significant differences were observed in 30-day mortality, freedom from CLTI, limb-salvage, or survival rates between the two groups.
• Dialysis patients showed significantly lower primary patency (PP) rates (39% vs. 64%; p=0.030).

Conclusions:

• Infrapopliteal bypass surgery for CLTI in dialysis patients yields comparable freedom from CLTI, limb salvage, and survival rates to non-dialysis patients.
• A notable finding is the reduced primary patency (PP) in dialysis patients following these procedures.
• Tertiary patency (TP) did not show a statistically significant difference between the groups.