Invited commentary

Abstract

The optimal management of critical limb ischemia (CLI) in dialysis-dependent patients (the majority of whom are diabetic) remains vexing and unsettled. In this study, Ramanan and colleagues1Ramanan B. Jeon-Slaughter H. Chen X. Modrall J.G. Tsai S. Comparison of open and endovascular procedures in patients with critical limb ischemia on dialysis.J Vasc Surg. 2019; 70: 1217-1224Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar have attempted to shed light on this difficult area of vascular practice. They conclude that “if feasible,” open revascularization should be considered an option for limb salvage in end-stage renal disease patients with CLI because of its association with a lower risk of major limb amputation, in spite of the higher rate of bleeding and wound complications, compared with endovascular revascularization. In their discussion, the authors have bravely and unabashedly summarized the limitations of this study, including the retrospective nature of the review, with inherent treatment choice selection bias; use of the limited National Surgical Quality Improvement Program database; only 30-day follow-up; lack of anatomic and lesion detail and procedural data; lack of Wound, Ischemia, and foot Infection (WIfI) classification; and unclear or unknown cardiovascular risk stratification. In spite of their diligent efforts, it appears that we will have to wait for the results of ongoing prospective randomized CLI treatment trials to obtain further clarity on the best management of this challenging clinical problem. This speaks to the inherently poor prognosis of the dialysis-dependent patient with CLI. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Comparison of open and endovascular procedures in patients with critical limb ischemia on dialysisJournal of Vascular SurgeryVol. 70Issue 4PreviewPeripheral artery disease is a common comorbidity in patients with end-stage renal disease (ESRD), but there is a paucity of data comparing outcomes of different interventions in this group of patients. In this study, we examined perioperative outcomes of lower extremity endovascular revascularization (ER) and open revascularization (OR) in dialysis patients with critical limb ischemia (CLI). Full-Text PDF Open Archive