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Relation of Baseline Renal Dysfunction With Outcomes in Patients Undergoing Popliteal and Infrapopliteal Percutaneous Peripheral Arterial Interventions

https://doi.org/10.1016/j.amjcard.2016.04.029Get rights and content

Renal dysfunction is a major risk factor for peripheral arterial disease (PAD). Infrapopliteal PAD is associated with more co-morbid conditions and worse prognosis than suprapopliteal PAD. Long-term outcomes of patients with renal dysfunction and popliteal or infrapopliteal PAD undergoing peripheral vascular intervention (PVI) are not well described. We retrospectively evaluated long-term outcomes in 726 patients undergoing infrapopliteal PVI categorized into 3 glomerular filtration rate (GFR)–based groups: GFR (≥60 ml/min/1.73 m2), GFR (<60 ml/min/1.73 m2), and those on dialysis. At mean follow-up of 36 ± 20 months, amputation rates were 3%, 5%, and 11% with mortality rates of 23%, 36%, and 56% in normal renal function, chronic kidney disease (adjusted odds ratio [OR] for amputation 1.75, 95% CI 0.73 to 4.21; adjusted OR for mortality 1.53, 95% CI 1.05 to 2.23, p = 0.028), and dialysis (adjusted OR for amputation 2.43, 95% CI 0.84 to 7.02, p = 0.100; adjusted OR for mortality 4.51, 95% CI 2.46 to 8.26, p <0.0001) groups, respectively. Repeat revascularization was similar in all 3 groups at roughly 25%. In conclusion, chronic kidney disease and dialysis were associated with increased major amputations and mortality in patients who received PVI for popliteal and infrapopliteal PAD.

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Methods

For the present study, we used data from patients in the Laser in Infra-popliteal and Popliteal Stenosis (LIPS) study. The details of this study have been previously published.8 In brief, LIPS was a retrospective study examining angiographic and short-term clinical outcomes of patients receiving percutaneous PVI for popliteal and infrapopliteal stenosis.8 All patients received either laser-assisted balloon angioplasty or balloon angioplasty alone. Data for LIPS were collected through

Results

Patients in the CKD group were older, whereas those on dialysis were younger compared with subjects with normal renal function (Table 1). Blacks accounted for significantly higher proportion of patients in the dialysis group. The prevalence of co-morbid conditions was higher in the CKD and dialysis groups. A history of previous limb amputation was fourfold greater in the dialysis group compared with the normal renal function group.

Postprocedural residual stenosis and procedural success were

Discussion

Our study suggested that in patients undergoing PVI, those with baseline renal dysfunction had worse long-term mortality and morbidities compared with those with normal renal function. Co-morbid conditions were greater in patients with CKD and dialysis. Nonetheless, adjusted long-term mortality remained significantly higher in CKD and worst in the dialysis group, suggesting that these factors were independently associated with worse outcomes. Similarly, baseline angiographic features were worse

Disclosures

The authors have no conflicts of interest to disclose.

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The study was funded by Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan.

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