Impact of chronic kidney disease on the outcomes of infrapopliteal venous, and heparin-bonded expanded polytetrafluoroethylene bypass surgeries: A retrospective cohort study

2021 ◽  
pp. 1358863X2110367
Author(s):  
Thomas Betz ◽  
Ingolf Toepel ◽  
Karin Pfister ◽  
Malisia Lang ◽  
Markus Steinbauer ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Patency Rate ◽  
Secondary Patency ◽  
Term Survival ◽  
Autologous Vein ◽  
Expanded Polytetrafluoroethylene ◽  
Vein Grafts ◽  
First Choice

The aim of this study was to analyze the results of infrapopliteal venous and prosthetic bypass surgeries for patients with chronic limb-threatening ischemia (CLTI) and moderate to severe chronic kidney disease (CKD). All consecutive patients undergoing infrapopliteal bypass surgeries at two academic vascular centers between March 2002 and November 2018 were included in this retrospective study. During this timeframe, infrapopliteal grafts were performed for 487 patients. Of these patients, 160 (32.9%; group 1) had normal renal function, 248 (50.9%; group 2) had moderate CKD, and 79 (16.2%; group 3) had severe CKD according to the Kidney Disease Improving Global Outcomes guidelines. After 5 years’ follow-up, the primary patency rate was 46.0% and the secondary patency rate was 54.9% without statistical significance noted between the CKD groups. Limb salvage (65.3%, p = 0.024) and long-term survival (19.6%, p < 0.001) were considerably lower in patients with severe CKD. In subgroup analysis, vein grafts had significantly better long-term patency rates compared to prosthetic grafts, regardless of CKD group. However, in patients with severe CKD, patency rates of vein and heparin-bonded expanded polytetrafluoroethylene (HePTFE) grafts were comparable at the 1-year mark. Our study shows that autologous vein grafts remain the first choice for infrapopliteal bypass surgeries in patients with CKD. HePTFE grafts showed good short-term results in patients with severe CKD. Given the short life expectancy of these high-risk patients, prosthetic HePTFE grafts may be reasonable in this population if a suitable vein is absent.

The Upper-Arm Basilic-Cephalic Loop: A Valueable Alternative for Below-Knee Arterial Reconstruction

2021 ◽  
pp. 153857442098061
Author(s):  
Florian K. Enzmann ◽  
Peter Metzger ◽  
Julio Ellacuriaga San Martin ◽  
Werner Dabernig ◽  
Fatema Akhavan ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Saphenous Vein ◽  
Bypass Graft ◽  
Primary Patency ◽  
Secondary Patency ◽  
Upper Arm ◽  
Autologous Vein ◽  
Tertiary Referral Center ◽  
Vein Grafts ◽  
First Choice

Introduction: Despite advances of endovascular interventions, bypass surgery remains the gold standard for treatment of long and complex arterial occlusions in the lower limb. Autologous vein is regarded superior to other options. As the graft of first choice, the great saphenous vein (GSV) is often not available due to previous bypass, stripping or poor quality. Other options like arm veins (AV) are important alternatives. As forearm portions of AVs are often unusable, a graft created from the upper arm basilic and cephalic veins provides a valuable alternative. Patients and Methods: We analyzed consecutive patients treated at an academic tertiary referral center between 01/1998 and 07/2018 using arm veins as the main peripheral bypass graft. Study endpoints were primary patency, secondary patency, limb salvage and survival. Results: In the observed time period 2702 bypass procedures were performed at our institution for below-knee arterial reconstructions. Vein grafts used included the ipsilateral GSV (iGSV; n = 1937/71.7%), contralateral GSV (cGSV; 192/7.1%), small saphenous vein (SSV; 133/4.9%), prosthetic conduits (61/2.3%) and different configurations of AV (379/14%). In the majority of patients receiving AV grafts a complete continuous cephalic or basilic vein (CAV) was used (n = 292/77%). If it was not possible to use major parts of these 2 veins, either spliced arm vein grafts (SAV) (42/11%) or an upper arm basilic-cephalic loop graft (45/12%) were used. Median follow-up was 27 (interquartile range: 8-50) months. After 3 years secondary patency (CAV: 85%; SAV: 62%; loop: 66%; p = 0.125) and limb salvage rates (CAV: 79%, SAV: 68%; loop: 79%; p = 0.346) were similar between the 3 bypass options. Conclusion: The encouraging results of alternative AV configurations highlight their value in case the basilic or cephalic veins are not useable in continuity. Especially for infragenual redo-bypass procedures, these techniques should be considered to offer patients durable revascularization options.

Hyperuricemia and long-term survival in patients with chronic kidney disease undergoing hemodialysis

2017 ◽  
Vol 88 (S1) ◽  
pp. 69-72 ◽  
Author(s):  
Tadej Petreski ◽  
Sebastjan Bevc ◽  
Robert Ekart ◽  
Radovan Hojs
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Does contrast media volume affect long-term survival in patients with chronic kidney disease?

2017 ◽  
Vol 2 (2) ◽  
pp. 82-89 ◽  
Author(s):  
Ismail Biyik ◽  
Fatih Uzun ◽  
Mehmet Erturk ◽  
Derya Ozturk ◽  
Ali Kemal Kalkan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Contrast Media ◽  
Term Survival ◽  
Long Term Survival ◽  
Media Volume

scholarly journals Diálise Peritoneal nos Dois Primeiros Anos de Vida: Experiência de uma Unidade de Nefrologia e Transplantação Renal Pediátrica

2016 ◽  
Vol 29 (9) ◽  
pp. 525
Author(s):  
Sofia Deuchande ◽  
Tânia Mano ◽  
Cristina Novais ◽  
Rute Machado ◽  
Rosário Stone ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Term Survival ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Peritoneal dialysis is the dialytic method of choice in chronic end-stage renal disease in children. This study main purposewas to characterize the long-term survival of a pediatric population who began peritoneal dialysis within the first two years of life.Material and Methods: A descriptive and retrospective study was performed in a portuguese nephrology and renal transplantation pediatric unit, between January 1991 and August 2014. End-stage renal disease etiology, mortality, comorbidities and complications of peritoneal dialysis and end-stage renal disease, growth and psychomotor development were evaluated.Results: Twenty children started peritoneal dialysis within the first two years of life. There were six deaths, but no deaths of children with primary chronic kidney disease were registered over the past decade. The 14 living children were characterized; 13 were males. Congenital abnormalities of the kidney and urinary tract were the leading etiology of chronic kidney disease (45%). The average age start of peritoneal dialysis was 6.1 months; six children started before 30 days of life. Peritonitis was the most frequent cause of hospitalization. Ten children were transplanted at an average age of 5.3 years. All of the children who are still in peritoneal dialysis have short stature, but nine of the transplanted have final height within the expected for their mid-parental height target range. Nine (64%)had some type of neurodevelopmental delay.Discussion: Peritoneal dialysis is a technique possible and feasible since birth, as evidenced in the study, as more than half of children successfully started it before 6 months of life. It allows long-term survival until the possibility of renal transplantation despite the associated morbidity, including peritonitis and complications of chronic renal disease. The ten transplanted children improved their growth, recovered from chronic anemia and improved dyslipidemia, compared with the period of dialysis. However, the average waiting time until the renal transplant was 5.3 years higher than other international centers.Conclusion: These data support the use of peritoneal dialysis from birth, but complications and the worst growth reflect the need to develop strategies to optimize care relating to nutrition, growth and development and to reduce pre-transplant time.

Comparison of venous and HePTFE tibial and peroneal bypasses in critical limb ischemia patients unsuitable for endovascular revascularization

Vascular ◽  
2015 ◽  
Vol 23 (6) ◽  
pp. 607-613 ◽  
Author(s):  
Christian Uhl ◽  
Carolin Hock ◽  
Thomas Betz ◽  
Markus Greindl ◽  
Ingolf Töpel ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Group Versus ◽  
Limb Ischemia ◽  
Primary Patency ◽  
Secondary Patency ◽  
Graft Material ◽  
Autologous Vein ◽  
Expanded Polytetrafluoroethylene ◽  
Endovascular Revascularization ◽  
First Choice

Background We examined short- and long-term outcomes of tibial and peroneal venous and heparin-bonded expanded polytetrafluoroethylene bypasses in patients with critical limb ischemia who were unsuitable for endovascular revascularization. Methods A retrospective analysis was done for all patients who underwent tibial and peroneal bypass surgery in our department between October 2007 and October 2012. Vein was the preferred graft material and used whenever possible. Results One hundred and ninety-eight crural grafts were included. Indications for the surgery were rest pain (30.3%) or ulcer or gangrene (69.7%). Autologous veins were used in 109 cases (vein group) and heparin-bonded expanded polytetrafluoroethylene grafts were used in 89 cases (heparin-bonded expanded polytetrafluoroethylene group). At three years, primary patency for the vein group was 68.2% versus 34.1% for the heparin-bonded expanded polytetrafluoroethylene group ( P = .000) and secondary patency was 69.8% versus 35.5% ( P = .001). Limb salvage was 81.8% for the vein group versus 56.5% for the heparin-bonded expanded polytetrafluoroethylene group ( P = .000) and survival was 62.8% versus 46.7% ( P = .019). Conclusions The results of our study show that autologous vein grafts are still first choice for tibial and peroneal bypasses in patients with critical limb ischemia. If no adequate vein is available, heparin-bonded expanded polytetrafluoroethylene bypasses are an acceptable alternative to an otherwise impending major amputation.

The Sleeve Method for Creation of Radiocephalic Arteriovenous Fistulas in Patients with Calcified Vessels

2017 ◽  
Vol 18 (5) ◽  
pp. 384-389 ◽  
Author(s):  
Tomasz Gołębiowski ◽  
Wacław Weyde ◽  
Krzysztof Letachowicz ◽  
Mariusz Kusztal ◽  
Hanna Augustyniak-Bartosik ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Patency Rate ◽  
Treatment Time ◽  
Chronic Kidney Disease Stage ◽  
Primary Patency ◽  
Disease Stage ◽  
Secondary Patency ◽  
Secondary Patency Rate ◽  
The Creation

Introduction Creation of an arteriovenous fistula (AVF) in patients with advanced atherosclerotic changes of the artery is often a challenge for the physician due to difficulties in suturing the vein to the side of the frangible artery. The sleeve technique relies on advancing the end of the artery into the lumen of the vein and protecting the anastomosis by adventitial sutures. Material and Methods The sleeve technique was performed in 23 patients with chronic kidney disease stage IV and V and included hemodialysis patients. Their mean age was 60.8 ± 14.8 years and hemodialysis treatment time 49.8 ± 40.2 months. The most frequent causes of chronic kidney disease are ischemic nephropathy (43%, n = 10) and type l diabetes (21%, n = 5). Only patients with extremely advanced atherosclerotic were recruited and analyzed. Results The primary patency rate was 67%, 59%, 44% and 28% at 6, 12, 24, and 36 months, respectively. The secondary patency rate was 67%, 61%, 50% and 37% at 6, 12, 24, and 36 months, respectively. In three patients the AVF failed directly after the operation. Delayed fistula failure occurred in seven patients. The overall success in the creation of a functioning fistula was achieved in 15 of the 23 patients (65%). No serious complications were observed. Conclusions In patients with calcified atherosclerotic plaques, which constitute a barrier or make it difficult to suture the vein to the side of the artery, the sleeve method may be considered as an alternative before abandoning the creation of a fistula on the forearm. The technique is much simpler than the standard end-to-side or side-to-side anastomosis.

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