Outcomes of chronic limb-threatening ischemia revascularization in patients with chronic kidney disease in the BEST-CLI trial.
Publication Title
Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
Document Type
Article
Publication Date
1-22-2025
Keywords
Amputation; BEST-CLI; Bypass; Chronic Kidney Disease; Dialysis; Endovascular; washington; spokane; pmrc
Abstract
BACKGROUND: Chronic limb-threatening ischemia (CLTI) in patients with chronic kidney disease (CKD) has a high risk of poor outcomes. We aimed to compare the outcomes of lower extremity revascularization in patients with CLTI stratified by CKD severity in patients enrolled in the prospective, randomized Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial.
METHODS: The BEST-CLI trial dataset was queried to categorize patients into three groups according to CKD stage. Group A includes non-CKD and CKD stages
RESULTS: A total of 1797 patients were included. Group C patients had double the risk of amputation (hazard ratio [HR], 2.13; P < .001), MALE, or all-cause mortality (HR, 2.05; P < .001) and more than triple the risk of all-cause mortality (HR, 3.40; P < .001) compared with group A. In dialysis-dependent patients, endovascular therapy was associated with better survival, but twice the risk of reintervention compared with surgical revascularization. According to spline model analysis, hazard of MALE or all-cause mortality increased sharply at eGFR
CONCLUSIONS: The progressive nature of renal impairment in patients with CLTI threatens their survival and limb salvage and may reduce the relative benefit of open vs endovascular revascularization seen in the overall BEST-CLI trial population. In dialysis-dependent patients, endovascular therapy was associated with lower mortality but increased reintervention rate.
Area of Special Interest
Cardiovascular (Heart)
Area of Special Interest
Kidney & Diabetes
Specialty/Research Institute
Cardiology
Specialty/Research Institute
Nephrology
Specialty/Research Institute
Endocrinology
DOI
10.1016/j.jvs.2024.12.128
