Document Detail

Infrainguinal bypass in patients with end-stage renal disease.
MedLine Citation:
PMID:  7878539     Owner:  NLM     Status:  MEDLINE    
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.
H R Baele; J J Piotrowski; J Yuhas; C Anderson; J J Alexander
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Publication Detail:
Type:  In Vitro; Journal Article    
Journal Detail:
Title:  Surgery     Volume:  117     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1995 Mar 
Date Detail:
Created Date:  1995-04-04     Completed Date:  1995-04-04     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  319-24     Citation Subset:  AIM; IM    
Case Western Reserve University School of Medicine, Cleveland, Ohio.
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MeSH Terms
Aged, 80 and over
Arteries / surgery
Inguinal Canal / blood supply*
Ischemia / etiology,  surgery*
Kidney Failure, Chronic / complications*
Leg / blood supply*
Life Tables
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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