Bypass Surgery as a Viable Option for Chronic Limb-threatening Ischemia Patients With Chronic Kidney Disease

Chronic limb-threatening ischemia (CLTI) represents the most severe manifestation of peripheral artery disease (PAD). Existing literature suggests that patients with chronic kidney disease (CKD) experience elevated rates of limb loss and mortality compared to non-CKD patients when undergoing bypass surgery for CLTI. This study seeks to compare limb salvage and mortality outcomes between non-CKD and CKD patients undergoing lower extremity bypass surgery. This retrospective cohort study included 208 consecutive patients who underwent lower extremity bypasses at a single high-volume center between 2018 and 2023. All variables were recorded in accordance with the Society of Vascular Surgery reporting guidelines. The primary end point was limb salvage at 1-year follow-up; secondary endpoints were major adverse events and mortality rate. A total of 118 non-CKD patients and 90 CKD patients underwent lower extremity bypasses. Hypertension, diabetes mellitus, and cardiac disease were identified as the most prevalent comorbidities in both non-CKD and CKD patients without significant differences between populations. The 1-year limb salvage rates were 80% for CKD patients and 79.7% for non-CKD patients, with a non-significant P-value of .995. Major amputations predominantly occurred within the first 100 days post-bypass surgery in both groups. Survival rates at 1 year were 88% for CKD patients and 94% for non-CKD patients. Notably, 53% of CKD patients presented with Rutherford classification 6, compared to 43% of non-CKD patients (P-value: .266). Amputation frequency was further assessed by CKD stage, revealing a 16% amputation risk for CKD stage 3, 28% for stage 4 and a 29% for CKD stage 5 (P-value: .653). Importantly, end-stage renal disease (ESRD) was not associated with a worse outcome in patients undergoing bypass surgery for revascularization. Limb salvage does not significantly differ between CKD and non-CKD patients, while CKD patients exhibit higher mortality rates. Non-CKD patients tend to present with a more severe Rutherford classification. Crucially, ESRD is not associated with a worse outcome in patients undergoing bypass surgery for revascularization. Bypass surgery should remain an option in CKD and ESRD patients with CLTI.