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Stavroulakis, Konstantinos; Gkremoutis, Asimakis; Borowski, Matthias; Torsello, Giovanni; Böckler, Dittmar; Zeller, Thomas; Steinbauer, Markus; Tsilimparis, Nikolaos; Bisdas, Theodosios; Adili, Farzin; Balzer, Kai; Billing, Arend; Brixner, Daniel; Debus, Sebastian E.; Florek, Hans-Joachim; Grundmann, Reinhardt; Hupp, Thomas; Keck, Tobias; Gerß, Joachim; Wojciech, Klonek; Lang, Werner; May, Björn; Meyer, Alexander; Mühling, Bernhard; [...]

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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  • Media type: E-Article
  • Title: Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry)
  • Contributor: Stavroulakis, Konstantinos; Gkremoutis, Asimakis; Borowski, Matthias; Torsello, Giovanni; Böckler, Dittmar; Zeller, Thomas; Steinbauer, Markus; Tsilimparis, Nikolaos; Bisdas, Theodosios; Adili, Farzin; Balzer, Kai; Billing, Arend; Brixner, Daniel; Debus, Sebastian E.; Florek, Hans-Joachim; Grundmann, Reinhardt; Hupp, Thomas; Keck, Tobias; Gerß, Joachim; Wojciech, Klonek; Lang, Werner; May, Björn; Meyer, Alexander; Mühling, Bernhard; [...]
  • Published: SAGE Publications, 2020
  • Published in: Journal of Endovascular Therapy, 27 (2020) 4, Seite 599-607
  • Language: English
  • DOI: 10.1177/1526602820938465
  • ISSN: 1526-6028; 1545-1550
  • Keywords: Cardiology and Cardiovascular Medicine ; Radiology, Nuclear Medicine and imaging ; Surgery
  • Origination:
  • University thesis:
  • Footnote:
  • Description: <jats:p> 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. </jats:p>