Tatsuya Shiraki1, Osamu Iida1, Mitsuyoshi Takahara2, Yoshimitsu Soga3, Shinsuke Mii4, Jin Okazaki5, Sosei Kuma5, Terutoshi Yamaoka6, Daisuke Kamoi7, Yoshiaki Shintani8, Toshinobu Ishikawa9, Ikuro Kitano10, Masaaki Uematsu1. 1. Kansai Rosai Hospital Cardiovascular Center. 2. Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine. 3. Department of Cardiology, Kokura Memorial Hospital. 4. Department of Vascular Surgery, Saiseikai Yahata General Hospital. 5. Department of Vascular Surgery, Kokura Memorial Hospital. 6. Department of Vascular Surgery, Matsuyama Red Cross Hospital. 7. Department of Cardiology, Nagoya Kyoritsu Hospital. 8. Department of Cardiology, Shin-Koga Hospital. 9. Department of Cardiology, Oita Oka Hospital. 10. Department of Surgery, Shinsuma General Hospital.
Abstract
AIM: The treatment strategy for hemodialysis (HD) patients with critical limb ischemia (CLI) has been clinically debatable. Here we compared clinical outcomes after bypass surgery (BSX) and after endovascular therapy (EVT) using propensity score matching. METHODS: A retrospective multicenter database of 246 (68 BSX and 178 EVT) consecutive HD patients with CLI (79% with tissue loss) who underwent infrainguinal revascularization from 2007 to 2009 was used to compare clinical outcomes, including overall survival (OS), major amputation (MA), major adverse limb event (MALE: repeat EVT, surgical reconstruction, or MA), and MALE-free survival after BSX vs. EVT using propensity score matching. RESULTS: The median (interquartile range) follow-up duration after revascularization was 21 (8-33) months. The analysis of the 63 propensity score-matched pairs revealed no significant difference in OS (53% vs. 52%, P=0.96), MA (25% vs. 14%, P=0.71), MALE (42% vs. 58%, P=0.63), and MALE-free survival (33% vs. 11%, P=0.37) at 3 year after BSX vs. EVT. CONCLUSIONS: In HD patients with CLI who underwent infrainguinal revascularization, OS, MA, MALE, and MALE-free survival rates were not significantly different after EVT vs. BSX. The less invasive EVT should be considered as the first-choice therapeutic strategy for HD patients with CLI.
AIM: The treatment strategy for hemodialysis (HD) patients with critical limb ischemia (CLI) has been clinically debatable. Here we compared clinical outcomes after bypass surgery (BSX) and after endovascular therapy (EVT) using propensity score matching. METHODS: A retrospective multicenter database of 246 (68 BSX and 178 EVT) consecutive HDpatients with CLI (79% with tissue loss) who underwent infrainguinal revascularization from 2007 to 2009 was used to compare clinical outcomes, including overall survival (OS), major amputation (MA), major adverse limb event (MALE: repeat EVT, surgical reconstruction, or MA), and MALE-free survival after BSX vs. EVT using propensity score matching. RESULTS: The median (interquartile range) follow-up duration after revascularization was 21 (8-33) months. The analysis of the 63 propensity score-matched pairs revealed no significant difference in OS (53% vs. 52%, P=0.96), MA (25% vs. 14%, P=0.71), MALE (42% vs. 58%, P=0.63), and MALE-free survival (33% vs. 11%, P=0.37) at 3 year after BSX vs. EVT. CONCLUSIONS: In HDpatients with CLI who underwent infrainguinal revascularization, OS, MA, MALE, and MALE-free survival rates were not significantly different after EVT vs. BSX. The less invasive EVT should be considered as the first-choice therapeutic strategy for HDpatients with CLI.
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