Infrainguinal bypass grafting in patients with end-stage renal disease: Improving outcomes?

Abstract

Objective: This study was undertaken to examine recent trends in the outcomes of patients with end-stage renal disease (ESRD) undergoing infrainguinal bypass grafting (IBG) with autogenous vein. Methods: A retrospective analysis of all IBGs performed on patients with ESRD at a single tertiary care institution during the interval 1993 to 1999 was undertaken. The comparison groups consisted of concurrent series of patients with elevated creatinine (creatinine level > 1.2 mg/dL) and patients with normal renal function undergoing IBG. Procedural variables, angiographic runoff scores, and extent of tissue necrosis at presentation were correlated with outcome. Categoric parameters were compared with χ2 analysis; rates were computed with life-table analysis. Results: Of an overall cohort of 622 IBGs performed during this interval, 78 IBGs (12.5%) were performed on 60 patients with ESRD, with a perioperative mortality rate of 1.3% that was comparable to controls. All reconstructions in the ESRD cohort were for limb salvage indications. Four-year survival, primary, assisted primary, and secondary patency rates for the ESRD group were 51% ± 9%, 60% ± 11%, 86% ± 5%, and 86% ± 5%, respectively; these were not statistically different from the control groups. Limb salvage in the ESRD group was 77% ± 6% at 4 years and was significantly less then either the elevated creatinine (92% ± 4%; P < .02) or the normal renal function group (90% ± 2%: P