Abstract 19137: Chronic Kidney Disease is an Important Predictor of 2-Year Mortality After Chronic Limb Ischemia Repair Using Either Endovascular or Bypass Graft Intervention

Abstract

Introduction: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are associated with worse outcomes after both endovascular (PVI) and bypass graft intervention (OI) of critical limb ischemia (CLI). Research Question: Do surgical outcomes of CLI repair differ by approach and CKD severity? Methods: Patients undergoing elective CLI intervention with preoperative renal function data captured by the Vascular Quality Initiative between Jan 2003 and Dec 2018 were analyzed. Patients were stratified by CKD class: normal/mild (CKD stage 1-2), moderate (CKD stage 3a), moderate-severe (CKD stage 3b), severe (CKD stage 4-5), and dialysis. Primary outcomes were 30-day, 1-year, and 2-year mortality, and incidence of major amputation. Predictors of survival were identified by Cox multivariate regression. Results: Out of 18,399 patients who underwent elective CLI treatment, 13,366 had PVI and 5033 had OI. Table 1 demonstrates the distribution of patients and primary outcomes. On Kaplan Meier analysis, 2-year survival favored the normal/moderate CKD cohort after both PVI and OI. On Cox regression analysis, when compared to normal/ mild CKD, CKD Class 3b (HR 1.405, p<0.001) and Class 4 (HR 1.712, p<0.001), and Class 5 (HR, 1.649, p = 0.070) were associated with worse 2-year mortality after OI. When compared to normal/mild CKD, CKD Class 3b (HR, 1.427 [1.2-1.7], p<0.001), Class 4 (HR, 2.256 [1.77-2.87], p<0.001), and Class 5 (HR, 1.210 [.59-2.5], p = 0.603) were associated with worse 2-year mortality. 2-year amputation rates did not demonstrate statistically significant differences among CKD classes. Conclusion: CKD severity is an important predictor of 2-year mortality after CLI repair regardless of approach but does not predict 2-year major amputation rates. Overall, PVI is associated with lower mortality and major amputation.