Infrainguinal bypass in end-stage renal disease: when is it justified?

Management of the patient with end stage renal disease and peripheral vascular disease represents a major challenge to the vascular surgeon. In this review, we developed guidelines for intervention based on our own institutional experience as well as literature review. There have been more than 290 patients reported to have 369 ischemic legs with threatened limb loss. There was an overall graft patency rate of 71% (range, 64% to 77%) and 60% (range, 48% to 90%) for 1 and 2 years, respectively. The mean limb salvage rate was 72% (range, 52% to 94%) at 2 years in these groups of patients. In the presence of rest pain and/or tissue loss, with favorable inflow and outflow (at least one vessel with direct flow into the foot), we strongly advised surgical bypass. In those patients who presented with rest pain and/or tissue loss, infragenicular surgical reconstruction led to a higher quality of life in comparison to patients with primary amputations. An indication for a primary amputation would be gangrene extending proximal to the mid foot. We have therefore outlined our findings and thoughts in the following article.