In-hospital outcomes in patients with critical limb ischemia and end-stage renal disease after revascularization.

Meyer, Alexander; Lang, Werner; Borowski, Matthias; Torsello, Giovanni; Bisdas, Theodosios; CRITISCH collaborators; Schmitz-Rixen, Thomas; Gkremoutis, Asimakis; Steinbauer, Markus; Betz, Thomas; Eckstein, Hans-Henning; Zimmermann, Alexander; Schelzig, Hubert; Oberhuber, Alexander; Florek, Hans-Joachim; May, Björn; Storck, Martin; Weis-Müller, Barbara; Reinhold, Christian; Böckler, Dittmar; Billing, Arend; Brixner, Daniel; Hupp, Thomas; Gerß, Joachim; Debus, Sebastian E; Spohn, Mathias; Reinecke, Holger; Schlensack, Christian; Donas, Konstantinos P; Stavroulakis, Konstantinos; Klonek, Wojciech; Wenk, Heiner; Trede, Matthias; Ritter, Ralf-Gerhard; Schulte, Karl-Ludwig; Keck, Tobias; Balzer, Kai; Mühling, Bernhard; Adili, Farzin; Grundmann, Reinhardt; Zeller, Thomas     «

Meyer, Alexander; Lang, Werner; Borowski, Matthias; Torsello, Giovanni; Bisdas, Theodosios; CRITISCH collaborators; Schmitz-Rixen, Thomas; Gkremoutis, Asimakis; Steinbauer, Markus; Betz, Thomas; Eckstein, Hans-Henning; Zimmermann, Alexander; Schelzig, Hubert; Oberhuber, Alexander; Florek, Hans-Joachim; May, Björn; Storck, Martin; Weis-Müller, Barbara; Reinhold, Christian; Böckler, Dittmar; Billing, Arend; Brixner, Daniel; Hupp, Thomas; Gerß, Joachim; Debus, Sebastian E; Spohn, Mathias; Reinecke,...     »

Analysis of in-hospital outcomes in patients treated for critical limb ischemia (CLI) and end-stage renal disease (ESRD) compared to CLI patients with normal renal function.A subgroup analysis of the German CRITISCH registry, a prospective multicenter registry, assessing the first-line treatment strategies in CLI patients in 27 vascular centers in Germany was performed. The study cohort was divided into ESRD patients (n = 102) and patients with normal renal function (n = 674; glomerular filtration rate>60/mL/min/1.73 m(2)). The following first-line treatment strategies were assessed: endovascular therapy (EVT), bypass surgery, patch plasty, and no vascular intervention (conservative treatment, primary amputation). Uni- and multivariate analyses were performed to identify differences between groups as to six end points: amputation or death (composite end point), amputation, death, hemodynamic failure, major adverse cardiac and cerebrovascular events, and reintervention.Differences between the ESRD and non-ESRD group were found regarding the applied first-line therapy (P = .016): The first-line treatment strategies in ESRD patients were EVT in 64% (n = 65), bypass surgery in 13% (n = 13), patch plasty in 11% (n = 11), and no vascular intervention in 13% (n = 13). In non-ESRD patients, EVT was applied in 48% (n = 326), bypass surgery in 27% (n = 185), patch plasty in 13% (n = 86), and no vascular intervention in 11% (n = 77). For ESRD patients, a noticeably increased risk of the composite end point (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.19-5.79; P = .017), amputation (OR, 3.14; 95% CI, 1.35-7.31; P = .008), and hemodynamic failure (OR, 2.19; 95% CI, 1.19-4.04; P = .012) was observed.CLI patients on dialysis represent a challenging cohort prone to in-hospital death, amputation, and hemodynamic failure. Two-thirds of these high-risk patients are treated with EVT. Present data suggest that this modality is generally considered as the most favorable treatment option in this patient subgroup.     «

Analysis of in-hospital outcomes in patients treated for critical limb ischemia (CLI) and end-stage renal disease (ESRD) compared to CLI patients with normal renal function.A subgroup analysis of the German CRITISCH registry, a prospective multicenter registry, assessing the first-line treatment strategies in CLI patients in 27 vascular centers in Germany was performed. The study cohort was divided into ESRD patients (n = 102) and patients with normal renal function (n = 674; glomerular filtrat...     »