Infrainguinal bypass in patients with end-stage renal disease: Survival and ambulation

The purpose of this study was to evaluate the outcomes of infrainguinal bypass surgery and ambulatory status in patients with end-stage renal disease (ESRD). Vascular registry data and the medical records of patients requiring infrainguinal bypass surgery from 1985 through 1995 were reviewed retrospectively. Patients with chronic limb-threatening ischemia requiring maintenance hemodialysis or peritoneal dialysis for greater than or equal to 6 months were compared to a randomly selected group of patients undergoing foot salvage infrainguinal bypass in the absence of ESRD. Primary outcomes were mortality, amputation, and ambulatory status at 30 days and 1 year. Data were analyzed using Pearson's chi-square methods, Fisher's Exact test, Mann-Whitney U, life table analyses, and Quality of Life-Class (QL-Class) ranking. There were 57 patients with ESRD who underwent 66 infrainguinal bypass procedures. Mean age was 65.8 +/- 9.8 years (41-85 years). The 30-day operative mortality rate was 12.3% (7 patients). The cumulative survival at 1 year was 51.8% +/- 0.9%, and at 2 years it was 32.8% +/- 1.3%. The cumulative limb loss was 29.7% +/- 1.1% at 1 year and 36.7% +/- 2.6% at 2 years. In the comparison group, 46 patients without ESRD underwent 50 infrainguinal bypass procedures. The mean age of these patients was 72.3 +/- 9.1 years (36-90 years). The cumulative survival for the patients without ESRD was significantly higher (p < 0.001) both at 1 year (91.1% +/- 0.6%) and 2 years (88.8% +/- 0.8%), The cumulative limb loss for the comparison group was significantly lower (p < 0.001) at 1 year (4.1% +/- 0.4%) and at 2 years (6.3% +/- 0.5%). At both 30 days and 1 year, the QL-Class walking status rating was Lower for the group with ESRD compared to patients without ESRD (p < 0.001). Patients with ESRD have a high mortality rate in the first 24 months after infrainguinal bypass grafting for foot salvage surgery compared with a similar group of patients without ESRD, Although foot salvage can be achieved in some survivors with ESRD, the ambulatory rate is low. These results support a very conservative approach when recommending infrainguinal bypass grafting for foot salvage surgery for patients with ESRD.