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Background. This study was undertaken to evaluate the outcome of infrainguinal arterial reconstruction
in a high-risk subset of patients with end-stage renal disease.
Methods. We reviewed the medical records of 44 patients requiring maintenance dialysis and
undergoing 57 infrainguinal bypass procedures for limb salvage from 1986 to 1992.
These included 16 (28%) femoropopliteal and 41 (72%) tibial or pedal bypasses with
autogenous (82%), prosthetic (12%), or composite (6%) graft materials. The principal
indications for operation were ischemic ulceration or gangrene (79%) and rest pain
(21%). Angiographic evaluation most frequently showed single-vessel runoff (56%).
Risk factors included age (mean, 63 years), diabetes (75%), hypertension (93%), coronary
artery disease (52%), smoking (39%), previous myocardial infarction (20%), and contralateral
amputation (18%). Infection was present in 22 limbs (39%).
Results. Early (30-day) surgical morbidity rate was 39%, including wound breakdown (19%),
graft thrombosis (9%), and major amputation (4%). Perioperative mortality rate was
9%. Cumulative primary graft patency rates were 71% and 63%, secondary patency rates
were 80% and 66%, and limb salvage rates were 70% and 52% at 1 and 2 years, respectively.
Limb loss correlated most highly with the presence of preoperative infection (p=0.036;
log-rank method). Patient survival rate was 52% at 2 years.
Conclusions. Life-table analysis confirms a poor life expectancy for this population but indicates
that an acceptable level of limb salvage may be achieved with arterial reconstruction
in properly selected patients.
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Article info
Publication history
Accepted:
June 9,
1994
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
