Author + information
- Desiree Dawson1,
- Jessica Atkins1,
- Nelson Telles Garcia1,
- George Mina2,
- Adrian Abreo1,
- Chiranjiv Virk1 and
- Paari Dominic1
Critical limb ischemia (CLI) is a severe form of PAD. ESRD is associated with increased morbidity and mortality following lower extremity amputation. Therefore, both angioplasty and bypass are used in ESRD patients with CLI; however, the treatment of choice remains controversial. We aimed to evaluate the long-term outcomes of ESRD compared to non-ESRD patients with CLI undergoing angioplasty or bypass.
PubMed, Web of Science, Cochrane and OVID databases were searched for studies comparing outcomes in ESRD compared to non-ESRD patients undergoing bypass or angioplasty for CLI. Most were retrospective studies, while two were prospective and observational. End points included survival, limb salvage, amputation free survival (AFS), primary and secondary patency at one year post procedure. Pooled odds ratio (OR) with 95% confidence intervals (CI) were calculated using a random effect model.
We included 15 studies with a total of 4,462 patients. Survival at 1 year post-angioplasty was not statistically significant for ESRD compared to non-ESRD patients (OR 0.63, 95% CI 0.36-1.09, p=0.099); however, survival was favored amongst non-ESRD post-bypass (OR 0.25, 95% CI 0.15-0.45, p<0.001). ESRD patients had lower rates of limb salvage post-bypass (OR 0.33, 95% CI 0.21-0.53, p<0.001) and post-angioplasty (OR 0.50, 95% CI 0.35-0.72, p<0.001). AFS was significantly higher in non-ESRD patients following angioplasty (OR 0.48, 95% CI 0.32-0.71, p<0.001) and bypass (OR 0.28, 95% CI 0.16-0.47, p<0.001). No significant difference was seen in primary patency post-angioplasty (OR 0.90, 95% CI 0.31-2.61, p=0.851) and post-bypass (OR 1.06, 95% CI 0.73-1.53, p=0.769) in ESRD compared to non-ESRD patients. Secondary patency was only studied in post-bypass patients, and was not different in ESRD and non-ESRD patients (OR 0.92, 95% CI 0.32-2.67, p=0.883).
At one year post angioplasty and bypass, ESRD patients had a worse outcome with reference to limb salvage, AFS and total survival, when compared to non-ESRD patients. Randomized controlled trials comparing these two modalities of treatment to each other and to conservative management in ESRD patients with CLI are needed to further clarify.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention