Factors influencing limb salvage and survival after amputation and revascularization in patients with end-stage renal disease☆

Abstract 

Background: Critical lower-extremity ischemia in patients with end-stage renal disease is associated with high operative mortality and low rates of limb salvage.

Patients and methods: The outcomes of 102 operations for lower-extremity ischemia in 77 patients with end-stage renal disease were analyzed to determine predictors of limb salvage and operative survival.

Results: Patients undergoing amputation (n = 50) and revascularization (n = 52) were similar in age, cause, and duration of renal failure, and prevalence of coronary artery disease. Operative mortality was 13% in revascularized patients and 20% in amputated patients, and was caused by sepsis in 12 of the 17 deaths (71%). Limb salvage in surviving patients was 91% at 30 days and 67% at 1 year. One-year survival was 72% in both groups. Factors associated with limb loss included advanced generalized atherosclerosis, extensive tissue necrosis, failed ipsilateral bypass, and poor cardiac functional status. Overall, factors associated with mortality included failure of limb salvage procedures, hemodynamic instability, and poor cardiac functional status.

Conclusions: More liberal use of primary amputation for end-stage renal disease patients with critical leg ischemia appears to be an important factor in improving both limb salvage rates and overall operative mortality.

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