Critical Limb Ischemia in Patients with End-Stage Renal Disease: Do Long-Term Results Justify An Aggressive Surgical Approach?

Abstract

End-stage renal disease (ESRD) patients probably represent the most difficult group of patients vascular surgeons are called upon to treat for critical limb ischemia. Advanced lower extremity arterial occlusive disease and frequent comorbidities make infrainguinal arterial bypass grafting (IABG) in this population both technically and medically challenging. Results of IABG are far inferior to those in non-ESRD patients. The greatest limitation to limb salvage appears to be progressive tissue necrosis and infection despite a patent bypass graft, a problem nearly unique to ESRD. Clinical predictors of outcome for IABG in this population have not been well established. The site and extent of tissue loss, the presence of associated infection, and the degree of pedal level occlusive disease have been identified as potentially important predictors. Improving outcome for ESRD patients with critical limb ischemia requires the establishment of firm guidelines for IABG to avoid futile and risky attempts at bypass in individuals better served by primary amputation.