End-Stage Renal Disease and Risk of Major Adverse Limb Events Following Peripheral Vascular Intervention

Sunday, March 5, 2023

4:21 PM – 4:30 PM

Location: Phoenix Convention Center, 222AB

Presenting Author(s)

YB

Yonatan B. Babore, BA (he/him/his)

Medical Student
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Disclosure information not submitted.

Author/Co-author(s)

Ansar Z. Vance, MD (he/him/his)

Attending Physician
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Rc

Raphael cohean, MD

Attending Physician
Division of Nephrology, Department of Medicine, Penn Presbyterian Medical Center, Philadelphia, PA
MM

Mark P. Mantell, MD

Attending Physician
Department of Surgery, Division of Vascular Surgery, Penn Presbyterian Medical Center, Philadelphia, PA
MT

Michael Troiano, DPM

Attending Physician
Department of Orthopedics, Division of Foot and Ankle Surgery, Penn Presbyterian Medical Center, Philadelphia, PA
AP

Andrew Peacock, DPM

Attending Physician
Department of Orthopedics, Division of Foot and Ankle Surgery, Penn Presbyterian Medical Center, Philadelphia, PA
Shilpa N. Reddy, MD

Assistant Professor, IR
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Timothy Clark, MD

Professor
University of Pennsylvania

Disclosure(s):

Ansar Z. Vance, MD: No relevant disclosure to display

Shilpa N. Reddy, MD: No financial relationships to disclose

Timothy Clark, MD: No relevant disclosure to display

Purpose: To examine the effect of end-stage renal disease (ESRD) on the likelihood of major adverse limb events (MALEs) in patients with critical limb ischemia (CLI) undergoing percutaneous vascular intervention (PVI).

Materials and Methods: Two contemporaneous cohorts of patients undergoing PVI for symptomatic CLI from 2012 to 2022, differing in ESRD status, were matched using propensity score methods. This database identified 628 patients undergoing 1297 lower extremity revascularization procedures; propensity score matching yielded 147 patients (180 limbs, 90 limbs in each group). Kaplan-Meier and Cox proportional hazard analyses were used to assess the effect of ESRD status on MALEs, stratified into major amputation (further stratified into above-knee amputation (AKA) and below-knee amputation (BKA)) and reintervention (PVI or bypass).

Results: After PVI, 31.3% of patients in the matched cohorts experienced a MALE (45.7% ESRD vs. 18.2% non-ESRD), and 15.6% experienced a major amputation (27.1% ESRD vs. 5.2% non-ESRD). Cox proportional hazards analysis revealed ESRD was an independent predictor of MALE (HR 3.15; 95% CI 1.58-6.29; p = 0.001), major amputation (HR 7.00; 95% CI 2.06-23.79; p = 0.002), and BKA (HR 7.56; 95% CI 1.71-33.50; p = 0.008).

Conclusion: ESRD is strongly predictive of MALE and major amputation risk, specifically BKA, in patients undergoing PVI for CLI. These patients warrant closer follow-up, and new methods may become necessary to predict and further reduce their amputation risk.