OUTCOME OF INFRAINGUINAL BYPASS-SURGERY FOR CRITICAL LEG ISCHEMIA IN PATIENTS WITH CHRONIC-RENAL-FAILURE

Objective: To determine whether infrainguinal bypass surgery is worthw hile in patients with critical limb ischaemia (CLI) and chronic renal failure. Design: Longitudinal observational study. Materials and Metho ds: Twenty-two patients with moderate renal failure indicated by serum creatinine level above 150 mu mol/l, 10 patients with end-stage renal disease requiring dialysis, and three patients with functioning kidne y transplant, underwent 39 bypass procedures for critical limb ischaem ia. Results: Six femoropopliteal, 14 femorocrural and 19 femoropenal b ypasses were performed. The immediate, 1-month, and 1-year primary pat ency rates were 97%, 84%, and 70%, respectively. The limb salvage was 93% at 1-month and 72% at 7-year follow-up. One-year patency and leg s alvage rates were 81% and 79% in non-dialysis patients, and 47% and 37 % in dialysis patients. At 1-year follow-up, 55% of surviving patients had salvaged limbs. None of the patients ill dialysis was alive with salvaged legs 4 months after revascularisation. Among preoperative ris k factors, only serum creatinine showed a statistical significance in predicting leg salvage and survival. Conclusions: As the outcome of pa tients on dialysis is very poor after infrainguinal bypass grafting, r evascularisation is seldom indicated. On the contrary, leg salvage can achieve good results in patients not requiring dialysis.