TY - JOUR
T1 - Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry)
AU - Stavroulakis, Konstantinos
AU - Gkremoutis, Asimakis
AU - Borowski, Matthias
AU - Torsello, Giovanni
AU - Böckler, Dittmar
AU - Zeller, Thomas
AU - Steinbauer, Markus
AU - Tsilimparis, Nikolaos
AU - Bisdas, Theodosios
AU - Adili, Farzin
AU - Balzer, Kai
AU - Billing, Arend
AU - Brixner, Daniel
AU - Debus, Sebastian E.
AU - Florek, Hans Joachim
AU - Grundmann, Reinhardt
AU - Hupp, Thomas
AU - Keck, Tobias
AU - Gerß, Joachim
AU - Wojciech, Klonek
AU - Lang, Werner
AU - May, Björn
AU - Meyer, Alexander
AU - Mühling, Bernhard
AU - Oberhuber, Alexander
AU - Reinecke, Holger
AU - Reinhold, Christian
AU - Ritter, Ralf Gerhard
AU - Schelzig, Hubert
AU - Schlensack, Christian
AU - Schmitz-Rixen, Thomas
AU - Schulte, Karl Ludwig
AU - Spohn, Matthias
AU - Storck, Martin
AU - Trede, Matthias
AU - Uhl, Christian
AU - Weis-Müller, Barbara
AU - Wenk, Heiner
AU - Zhorzel, Sven
AU - Zimmermann, Alexander
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the German Society of Vascular Surgery and Medicine (Deutsche Gesellschaft für Gefäßchirurgie and Gefäßmedizin).
Publisher Copyright:
© The Author(s) 2020.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85087733169&partnerID=8YFLogxK
U2 - 10.1177/1526602820938465
DO - 10.1177/1526602820938465
M3 - Journal articles
C2 - 32633651
AN - SCOPUS:85087733169
SN - 1526-6028
VL - 27
SP - 599
EP - 607
JO - Journal of Endovascular Therapy
JF - Journal of Endovascular Therapy
IS - 4
ER -
