Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry)

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; Alexander Zimmermann

doi:10.1177/1526602820938465

Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry)

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 WojciechWerner 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, Alexander Zimmermann

^*Corresponding author for this work

12 Citations (Scopus)

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.

Original language	English
Journal	Journal of Endovascular Therapy
Volume	27
Issue number	4
Pages (from-to)	599-607
Number of pages	9
ISSN	1526-6028
DOIs	https://doi.org/10.1177/1526602820938465
Publication status	Published - 01.08.2020

Funding

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).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1177/1526602820938465

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Stavroulakis, K., Gkremoutis, A., Borowski, M., Torsello, G., Böckler, D., Zeller, T., Steinbauer, M., Tsilimparis, N., Bisdas, T., Adili, F., Balzer, K., Billing, A., Brixner, D., Debus, S. E., Florek, H. J., Grundmann, R., Hupp, T., Keck, T., Gerß, J., ... Zimmermann, A. (2020). Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry). Journal of Endovascular Therapy, 27(4), 599-607. https://doi.org/10.1177/1526602820938465

@article{9491af573688476ea43226fecbb7868d,

title = "Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry)",

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.",

author = "Konstantinos Stavroulakis and Asimakis Gkremoutis and Matthias Borowski and Giovanni Torsello and Dittmar B{\"o}ckler and Thomas Zeller and Markus Steinbauer and Nikolaos Tsilimparis and Theodosios Bisdas and Farzin Adili and Kai Balzer and Arend Billing and Daniel Brixner and Debus, \{Sebastian E.\} and Florek, \{Hans Joachim\} and Reinhardt Grundmann and Thomas Hupp and Tobias Keck and Joachim Ger{\ss} and Klonek Wojciech and Werner Lang and Bj{\"o}rn May and Alexander Meyer and Bernhard M{\"u}hling and Alexander Oberhuber and Holger Reinecke and Christian Reinhold and Ritter, \{Ralf Gerhard\} and Hubert Schelzig and Christian Schlensack and Thomas Schmitz-Rixen and Schulte, \{Karl Ludwig\} and Matthias Spohn and Martin Storck and Matthias Trede and Christian Uhl and Barbara Weis-M{\"u}ller and Heiner Wenk and Sven Zhorzel and Alexander Zimmermann",

note = "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 f{\"u}r Gef{\"a}{\ss}chirurgie and Gef{\"a}{\ss}medizin). Publisher Copyright: {\textcopyright} The Author(s) 2020. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

month = aug,

day = "1",

doi = "10.1177/1526602820938465",

language = "English",

volume = "27",

pages = "599--607",

journal = "Journal of Endovascular Therapy",

issn = "1526-6028",

publisher = "SAGE Publications Inc.",

number = "4",

}

Stavroulakis, K, Gkremoutis, A, Borowski, M, Torsello, G, Böckler, D, Zeller, T, Steinbauer, M, Tsilimparis, N, Bisdas, T, Adili, F, Balzer, K, Billing, A, Brixner, D, Debus, SE, Florek, HJ, Grundmann, R, Hupp, T, Keck, T, Gerß, J, Wojciech, K, Lang, W, May, B, Meyer, A, Mühling, B, Oberhuber, A, Reinecke, H, Reinhold, C, Ritter, RG, Schelzig, H, Schlensack, C, Schmitz-Rixen, T, Schulte, KL, Spohn, M, Storck, M, Trede, M, Uhl, C, Weis-Müller, B, Wenk, H, Zhorzel, S & Zimmermann, A 2020, 'Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry)', Journal of Endovascular Therapy, vol. 27, no. 4, pp. 599-607. https://doi.org/10.1177/1526602820938465

Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry). / Stavroulakis, Konstantinos; Gkremoutis, Asimakis; Borowski, Matthias et al.
In: Journal of Endovascular Therapy, Vol. 27, No. 4, 01.08.2020, p. 599-607.

Research output: Journal Articles › Journal articles › Research › peer-review

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 - https://www.scopus.com/pages/publications/85087733169

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 -

Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry)

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