当前位置： SCI文献检索 > JOURNAL OF VASCULAR SURGERY期刊下所有文献 > Influence of renal insufficiency on limb loss and mortality after initial lower extremity surgical revascularization.

Influence of renal insufficiency on limb loss and mortality after initial lower extremity surgical revascularization.

Abstract：

OBJECTIVE:Limb loss after lower extremity surgical revascularization occurs relatively frequently in patients receiving dialysis. The goal of the present study was to determine whether patients with milder degrees of renal insufficiency are also at risk for this complication. MATERIAL AND METHODS:This cohort study was carried out at the Department of Veterans Affairs (VA). The study sample consisted of 9932 patients undergoing an initial surgical revascularization procedure between October 1, 1995, and September 30, 2000, recorded by the VA National Surgical Quality Improvement Program (NSQIP). We examined the occurrence of major amputation within 1 year of lower extremity surgical revascularization by level of renal function. RESULTS:Eleven percent of study patients underwent major lower extremity amputation within 1 year of NSQIP-documented lower extremity revascularization surgery: 10% (739 of 7335) of patients with normal renal function, 11% (251 of 2210) of patients with moderately reduced renal function, 12% (24 of 205) of patients with severe renal insufficiency, and 29% (53 of 182) of patients receiving dialysis. After adjustment for demographic characteristics and comorbid conditions, only patients receiving dialysis were at significantly increased risk for amputation, compared with patients with normal renal function (odds ratio, 2.46; 95% confidence interval, 1.74-3.47; P<.001). Compared with all other veterans undergoing bypass procedures, patients receiving dialysis were more likely to have a wound infection; a diagnostic code for lower extremity gangrene, infection, or ischemic ulceration; an elevated white blood cell count; and preoperative sepsis at the time of initial revascularization. In addition, they were more likely to have a preoperative hospital stay longer than 1 week, undergo concurrent minor amputation, and undergo an outflow (vs inflow) procedure. CONCLUSION:Only patients receiving dialysis, and not patients with milder degrees of renal insufficiency, appear to be at higher risk for limb loss after revascularization, compared with patients with normal renal function. Further studies are needed to determine why patients receiving dialysis are at a singularly increased risk for limb loss after lower extremity revascularization and whether their more frequent presentation with limb-threatening infection at the time of revascularization reflects late presentation for surgery or a more rapid course of peripheral arterial disease in this patient group.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

O'Hare AM,Sidawy AN,Feinglass J,Merine KM,Daley J,Khuri S,Henderson WG,Johansen KL

doi

10.1016/j.jvs.2003.11.038

subject

Has Abstract

pub_date

2004-04-01 00:00:00

pages

709-16

issue

eissn

0741-5214

issn

1097-6809

pii

S0741521403017403

journal_volume

pub_type

杂志文章

在线工具

Influence of renal insufficiency on limb loss and mortality after initial lower extremity surgical revascularization.