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Comparison of Modern Results in Patients With and Without ESRD

James M. Edwards, MD; Lloyd M. Taylor, Jr, MD; John M. Porter, MD

Arch Surg. 1988;123(9):1164-1168.

Abstract
• We reviewed our experience with femoral-popliteal-tibial reversed vein bypasses performed for limb salvage in 226 patients without and 19 patients with end-stage renal disease (ESRD). While 18-month primary patency rates were comparable (85% and 89%), limb salvage was significantly lower (76% vs 95%) in patients with ESRD. Five amputations in the ESRD group were required for nonhealing, large foot ulcers in diabetic patients despite patent arterial bypass while only five of 13 amputations in patients without ESRD were required in the presence of patent grafts. The need for major amputation despite patent bypass in diabetic patients with ESRD who have extensive foot gangrene or ischemic ulceration occurs sufficiently often that we recommend primary amputation be considered in these patients without regard to possible vascular reconstruction.

(Arch Surg 1988;123:1164-1168)

Author Affiliations
From the Division of Vascular Surgery, Oregon Health Sciences University, Portland.

Footnotes
Accepted for publication May 16, 1988.

Read before the 59th Annual Meeting of the Pacific Coast Surgical Association, San Francisco, Feb 24, 1988.

Reprint requests to OP-11, Division of Vascular Surgery, Oregon Health Sciences University, 3181 Sam Jackson Park Rd, Portland, OR 97201 (Dr Porter).

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