Outcome of infrainguinal bypass surgery for critical leg ischaemia in patients with chronic renal failure

Objective: To determine whether infrainguinal bypass surgery is worthwhile in patients with critical limb ischaemia (CLI) and chronic renal failure. Design: Longitudinal observational study. Materials and Methods: Twenty-two patients with moderate renal failure indicated by serum creatinine level above 150 mu mol/l, 10 patients with end-stage renal disease requiring dialysis, and three patients with functioning kidney transplant, underwent 39 bypass procedures for critical limb ischaemia. Results: Six femoropopliteal, 14 femorocrural and 19 femoropenal bypasses were performed. The immediate, 1-month, and 1-year primary patency rates were 97%, 84%, and 70%, respectively. The limb salvage was 93% at 1-month and 72% at 7-year follow-up. One-year patency and leg salvage rates were 81% and 79% in non-dialysis patients, and 47% and 37% in dialysis patients. At 1-year follow-up, 55% of surviving patients had salvaged limbs. None of the patients ill dialysis was alive with salvaged legs 4 months after revascularisation. Among preoperative risk factors, only serum creatinine showed a statistical significance in predicting leg salvage and survival. Conclusions: As the outcome of patients on dialysis is very poor after infrainguinal bypass grafting, revascularisation is seldom indicated. On the contrary, leg salvage can achieve good results in patients not requiring dialysis.