OUTCOMES FOLLOWING PERIPHERAL VASCULAR INTERVENTIONS IN PATIENTS WITH END STAGE RENAL DISEASE ON DIALYSIS
Sateesh C. Babu, M.D., Ankoor H. Patel, MD, Murad Elias, MD, Priya Goyal, MD, ARUN GOYAL, MD, Romeo B. Mateo, MD, Igor Laskowski, MD. ,Ph.D, Christopher Hall.
WESTCHESTER MEDICAL CENTER/NEW YORK MEDICAL COLLEGE, Valhalla, NY, USA.
Title: Outcomes Following Peripheral Vascular Interventions in Patients on dialysis
Objective: The aim of this study was to review post-operative outcomes - mortality, readmissions, and amputations in patients with end stage renal disease (ESRD) and Peripheral Arterial Disease (PAD). Methods: Retrospective analysis of patients from a single institution with PAD and ESRD on dialysis, who had vascular interventions from 2015-2017. Results: A total of 74 patients met the inclusion criteria. Males were predominant, mean age of 65 years. The most common co-morbidities were hypertension (85%), diabetes (63.5%), heart failure (37%), myocardial infarction (24%), and stroke (16.2%). Patients underwent both open and endovascular procedures. Endovascular angioplasty/stenting was performed in 91% of patients, majority in popliteal and tibio-peroneal arteries (49%). Amongst open procedures, lower extremity bypasses and endarterectomy was done in 61%, surgical debridement on index and surgical wounds in 54% of patients. In this cohort, toe amputation in 47% was most common, trans-metatarsal amputation (TMA) in 31%, below-knee amputation (BKA) in 18% and above-knee amputation (AKA) in 8%. The mortality was 10%. Failure of endovascular procedures leading to bypass or amputation occurred in 32% and failure of bypass occurred in 12% for a total failure of treatment in 43% . The 30, 90, and 120-day readmission rates were 15%, 20%, and 27% respectively. The most common reason for readmissions was wound related in 23% (non-healing 11%, infection 12%) followed by failure of bypass or stent stenosis/occlusion in 12.2% (n=9). Mean hospital stay in this cohort was 38+47days. On multivariable binary logistic regression; stroke (OR 6.37, 95% CI 1.62-35, p<0.01) and age (OR 0.94, 95% CI 0.91-0.99, p=0.05) were independently associated with high odds of readmission. AKA (OR 8.01, 95% CI 1.21-53.3, p=0.03) and female gender (OR, 14.45, 95% CI 1.73-120.75, p=0.01) were independent risk factors associated with higher odds of mortality. The discriminatory power for predictive models for readmission and mortality was obtained on the ROC curve with area under the curve (AUC) of 0.714 and 0.840 respectively.
Conclusion: PAD in patients on dialysis is associated with long hospital stays as well as high amputation and readmission rates. Despite advances in balloons, stents, and surgical techniques, treatment failure occurred in roughly half of patients. Further prospective studies to identify independent predictors of negative outcomes are needed.
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