1. Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry)
- Author
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Konstantinos Stavroulakis, Asimakis Gkremoutis, Matthias Borowski, Giovanni Torsello, Dittmar Böckler, Thomas Zeller, Markus Steinbauer, Nikolaos Tsilimparis, Theodosios Bisdas, Farzin Adili, Kai Balzer, Arend Billing, Daniel Brixner, Sebastian E. Debus, Hans-Joachim Florek, Reinhardt Grundmann, Thomas Hupp, Tobias Keck, Joachim Gerß, Klonek Wojciech, Werner Lang, Björn May, Alexander Meyer, Bernhard Mühling, Alexander Oberhuber, Holger Reinecke, Christian Reinhold, Ralf-Gerhard Ritter, Hubert Schelzig, Christian Schlensack, Thomas Schmitz-Rixen, Karl-Ludwig Schulte, Matthias Spohn, Martin Storck, Matthias Trede, Christian Uhl, Barbara Weis-Müller, Heiner Wenk, Sven Zhorzel, and Alexander Zimmermann
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Risk Assessment ,Amputation, Surgical ,Peripheral Arterial Disease ,Ischemia ,Risk Factors ,Germany ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Registries ,Myocardial infarction ,Renal Insufficiency, Chronic ,Aged ,Aged, 80 and over ,Framingham Risk Score ,Proportional hazards model ,business.industry ,Endovascular Procedures ,Hazard ratio ,Critical limb ischemia ,Limb Salvage ,medicine.disease ,Confidence interval ,Treatment Outcome ,Amputation ,Chronic Disease ,Female ,Vascular Grafting ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
Purpose: To report the outcomes of bypass grafting (BG) vs endovascular therapy (EVT) in patients with non-dialysis-dependent chronic kidney disease (CKD) and chronic limb-threatening ischemia (CLTI). Materials and Methods: The CRITISCH Registry is a prospective, national, interdisciplinary, multicenter registry evaluating the current practice of all available treatment options in 1200 consecutive CLTI patients. For the purposes of this analysis, only the 337 patients with non-dialysis-dependent CKD treated by either BG (n=86; median 78 years, 48 men) or EVT (n=251; median age 80 years, 135 men) were analyzed. The primary composite outcome was amputation-free survival (AFS); secondary outcomes were overall survival (OS) and amputation-free time (AFT). All outcomes were evaluated in Cox proportional hazards models; the results are reported as the hazard ratio (HR) and 95% confidence interval (CI). Results: The Cox regression analysis revealed a significantly greater hazard of amputation or death after BG (HR 1.78, 95% CI 1.05 to 3.03, p=0.028). The models for AFT and overall survival also suggested a higher hazard for BG, but the differences were not significant (AFT: HR 1.66, 95% CI 0.78 to 3.53, p=0.188; OS: HR 1.41, 95% CI 0.80 to 2.47, p=0.348). The absence of runoff vessels (HR 1.73, 95% CI 1.15 to 2.60, p=0.008) was associated with a decreased AFS. The likelihood of amputation was higher in male patients (HR 2.21, 95% CI 1.10 to 4.45, p=0.027) and was associated with a lack of runoff vessels (HR 1.95, 95% CI 0.96 to 3.95, p=0.065) and myocardial infarction (HR 3.74, 95% CI 1.23 to 11.35, p=0.020). Death was more likely in patients without runoff vessels (HR 1.76, 95% CI 1.11 to 2.80, p=0.016) and those with a higher risk score (HR 1.73, 95% CI 1.03 to 2.91, p=0.038). Conclusion: This analysis suggested that BG was associated with poorer AFS than EVT in patients with non-dialysis-dependent CKD and CLTI. Male sex, previous myocardial infarction, and the absence of runoff vessels were additionally identified as predictors of poorer outcomes.
- Published
- 2020
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