| Infrainguinal bypass in patients with end-stage renal disease. | |
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MedLine Citation:
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PMID: 7878539 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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H R Baele; J J Piotrowski; J Yuhas; C Anderson; J J Alexander |
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Publication Detail:
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Type: In Vitro; Journal Article |
Journal Detail:
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Title: Surgery Volume: 117 ISSN: 0039-6060 ISO Abbreviation: Surgery Publication Date: 1995 Mar |
Date Detail:
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Created Date: 1995-04-04 Completed Date: 1995-04-04 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 0417347 Medline TA: Surgery Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 319-24 Citation Subset: AIM; IM |
Affiliation:
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Case Western Reserve University School of Medicine, Cleveland, Ohio. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Arteries / surgery Humans Inguinal Canal / blood supply* Ischemia / etiology, surgery* Kidney Failure, Chronic / complications* Leg / blood supply* Life Tables Male Middle Aged Postoperative Complications Retrospective Studies Risk Factors Treatment Outcome Vascular Patency |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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