Document Detail


Impact of incidental renal artery stenosis on long-term mortality in patients with peripheral arterial disease undergoing vascular procedure.
MedLine Citation:
PMID:  21798691     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In peripheral arterial disease (PAD), mortality is high. Incidental renal artery stenosis (RAS) is a predictor of mortality in PAD patients undergoing angiography. This might be relevant for risk-benefit assessment when vascular surgery is considered, both in terms of perioperative risk, and in terms of life expectancy.
METHODS: We studied the prognostic impact of incidental RAS in 488 subjects (334 men, 154 women; mean follow-up 6.0 ± 3.4 years) who underwent angiography for PAD in a single center between 1997 and 2000. Renal arteries were visualized and follow-up data concerning vascular procedures were analyzed.
RESULTS: RAS (diameter reduction >50%) was present in 26%. Forty-six percent of study patients underwent a vascular procedure (85% vascular surgery, remainder underwent amputation). Patients that underwent vascular surgery had a better renal function at baseline, less history of stroke, and a larger proportion of smokers. Overall mortality was similar for patients that underwent surgery (54.5%) and those without surgery (49.6%). There was no difference in 90-day postoperative mortality for patients without or with RAS (7.2% vs 10.3%; NS). For subjects that underwent bypass surgery, long-term mortality was substantially and significantly higher among those with RAS (65.1%) vs those without RAS (43.5%). On Cox regression analysis, age was the only independent predictor of 90-day postoperative mortality. The well-known cardiovascular risk factors of age, diabetes mellitus, history of prior peripheral vascular disease, smoking, prior myocardial infarction, prior stroke, and amputation, as well as presence of RAS, were independent predictors for overall mortality.
CONCLUSION: In PAD, incidental RAS predicts long-term mortality independent of other risk factors. The elevated mortality is not due to a higher postoperative risk. Subjects presenting with PAD and RAS can therefore undergo vascular procedures with the same risk as other patients.
Authors:
Kwok-Wai Mui; Clark J Zeebregts; Huib van den Hout; Jef G van Baal; Gerjan Navis; Arend Jan-Woittiez
Publication Detail:
Type:  Journal Article     Date:  2011-07-27
Journal Detail:
Title:  Journal of vascular surgery     Volume:  54     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-05     Completed Date:  2011-11-10     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  785-90     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. kw.mui@stjansdal.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiography, Digital Subtraction
Chi-Square Distribution
Female
Humans
Incidental Findings*
Kaplan-Meier Estimate
Male
Middle Aged
Netherlands
Patient Selection
Peripheral Arterial Disease / complications,  mortality,  radiography,  surgery*
Predictive Value of Tests
Proportional Hazards Models
Renal Artery Obstruction / complications,  mortality*,  radiography
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Vascular Surgical Procedures / adverse effects,  mortality*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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