Does renal failure influence infrainguinal bypass graft outcome?

Area of Science:

• Vascular Surgery
• Nephrology
• Clinical Outcomes Research

Background:

• Infrainguinal bypass grafting is a critical procedure for limb salvage.
• The impact of renal failure (RF) on infrainguinal bypass outcomes requires further clarification.
• Co-morbidities like hypertension, diabetes, and cardiac disease are prevalent in RF patients undergoing vascular surgery.

Purpose of the Study:

• To evaluate the role of renal failure (RF) in infrainguinal bypass graft outcomes.
• To compare graft patency, limb salvage, and survival rates between patients with and without RF.
• To assess perioperative morbidity in RF patients undergoing infrainguinal bypass.

Main Methods:

• Retrospective analysis of 206 patients undergoing 241 infrainguinal bypass grafts between 1990 and 1996.
• Categorization of patients into renal insufficiency (RI), end-stage renal disease (ESRD), and non-RF groups.
• Life table analysis for primary patency, secondary patency, limb salvage, and survival rates.

Main Results:

• Thirty-three RF patients (20 ESRD, 14 RI) were included.
• Perioperative morbidity was significantly higher in the ESRD group compared to RI and non-RF groups (P = 0.019).
• No significant differences were observed in primary patency (P = 0.56), secondary patency (P = 0.96), or limb salvage (P = 0.69) between ESRD and non-RF groups.
• Overall survival rate was significantly decreased in the ESRD group (P < 0.01).

Conclusions:

• Infrainguinal vein bypass grafting can be successfully performed in renal failure patients, offering comparable patency and limb salvage.
• While graft success is achievable, renal failure, particularly ESRD, is associated with increased perioperative morbidity and reduced long-term survival.
• Optimizing perioperative care and patient selection is crucial for improving outcomes in RF patients undergoing infrainguinal bypass.