Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Department of Vascular and Endovascular Surgery, Frankfurt University Hospital, Frankfurt, Germany.
Ann Vasc Surg. 2024 Nov;108:365-374. doi: 10.1016/j.avsg.2024.06.014. Epub 2024 Jul 14.
The aim of this study is to present short- and long-term outcomes after lower extremity bypass (LEB) surgery in patients with chronic limb-threatening ischemia and chronic kidney disease (CKD), differentiated by peripheral artery disease (PAD) Fontaine stage III and IV.
Retrospective analysis of anonymized data from a nationwide German health insurance company (AOK). Data from 22,633 patients (14,523 men) who underwent LEB from 2010 to 2015 were analyzed, presenting 18,271 with CKD stage 1/2, 2,483 patients with CKD stage 3, and 1,879 with CKD stage 4/5.
Perioperative mortality (60-day mortality) was 7.2% for CKD stage 1/2, 12.4% for CKD stage 3, and 19.8% for CKD stage 4/5. Patients with PAD stage IV had significantly higher perioperative mortality (10.3%) than patients with PAD stage III (4.5%). The perioperative major amputation rate depended significantly on PAD stage IV (odds ratio [OR]: 2.57 confidence interval [CI]: 2.16-3.05, P < 0.001), the LEB level below the knee and crural/pedal (OR: 2.49 CI: 2.14-2.90, P < 0.001), CKD stage 4/5 (OR: 1.28, CI: 1.06-1.54, P = 0.009), and the presence of diabetes mellitus type 2 (OR: 1.19, CI: 1.05-1.36, P = 0.007). Kaplan-Meier estimated long-term survival of up to 9 years after surgery was 31.7% for patients with CKD stage 1 and 2, 14.3% for CKD stage 3, and only 10.1% for CKD stage 4 and 5 (P < 0.001). PAD Fontaine stage IV versus III (hazard ratio: 1.64, CI: 1.56-1.71, P < 0.001), but not bypass level, had an independent adverse influence on long-term survival.
CKD and PAD stage were equally significant independent predictors of patient survival and major adverse cardiovascular events with higher PAD and CKD stages associated with less favorable long-term outcomes.
本研究旨在呈现慢性肢体威胁性缺血和慢性肾脏病（CKD）患者下肢旁路（LEB）手术后的短期和长期结果，并根据外周动脉疾病（PAD）Fontaine 分期 III 和 IV 进行区分。
对德国一家全国性健康保险公司（AOK）的匿名数据进行回顾性分析。分析了 2010 年至 2015 年间接受 LEB 的 22633 名患者（14523 名男性）的数据，其中 18271 名患者患有 CKD 1/2 期，2483 名患者患有 CKD 3 期，1879 名患者患有 CKD 4/5 期。
围手术期死亡率（60 天死亡率）在 CKD 1/2 期为 7.2%，在 CKD 3 期为 12.4%，在 CKD 4/5 期为 19.8%。PAD 分期 IV 的患者围手术期死亡率显著高于 PAD 分期 III（10.3% vs. 4.5%）。围手术期主要截肢率与 PAD 分期 IV 显著相关（比值比[OR]：2.57 置信区间[CI]：2.16-3.05，P<0.001），膝下和小腿/足部的 LEB 水平（OR：2.49 CI：2.14-2.90，P<0.001）、CKD 4/5 期（OR：1.28，CI：1.06-1.54，P=0.009）和 2 型糖尿病的存在（OR：1.19，CI：1.05-1.36，P=0.007）。术后长达 9 年的 Kaplan-Meier 估计长期生存率在 CKD 1 和 2 期为 31.7%，在 CKD 3 期为 14.3%，在 CKD 4 和 5 期仅为 10.1%（P<0.001）。PAD Fontaine 分期 IV 与 III（风险比：1.64，CI：1.56-1.71，P<0.001），而不是旁路水平，对长期生存率有独立的不利影响。
CKD 和 PAD 分期是患者生存和主要不良心血管事件的同等重要的独立预测因素，较高的 PAD 和 CKD 分期与预后较差相关。
