Chronic Kidney Disease and Risk of Mortality and Major Adverse Limb Events After Femoral Artery Endovascular Revascularization for Peripheral Artery Disease: The Boston Femoral Artery Endovascular Revascularization Outcomes (Boston FAROUT) Study

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2025-02-10 DOI:10.1002/ccd.31447

Peter Evans, Piotr Sobieszczyk, Andrew C. Eisenhauer, Thomas M. Todoran, Scott Kinlay

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Abstract

Background

Chronic kidney disease (CKD) is associated with worse outcomes in peripheral artery disease (PAD). The impact of the severity of CKD on mortality and major adverse limb events (MALE) after endovascular revascularization of the superficial femoral artery (SFA) is unknown.

Aims

To assess the relationship of increasing severity of CKD on the risk of mortality and MALE in patients after endovascular revascularization of the SFA.

Methods

We followed a cohort of 202 patients (253 limbs) with SFA endovascular revascularization for claudication or chronic limb-threatening ischemia in two academic centers between 2003 and 2011. Patients were categorized into four Kidney Disease Improving Global Outcomes (KDIGO) categories of increasingly worse CKD based on estimated glomerular filtration rate (eGFR). The primary outcome was all-cause death. Secondary outcomes included cardiovascular death, noncardiovascular death, and MALE. The relationship between CKD severity and outcomes was assessed by hazard ratios (HR) and 95% confidence intervals (95%CI) from cause-specific multivariable Cox proportional hazards models and Fine-Gray competing risks analyses.

Results

During a median follow-up of 9.3 years, there was a graded and increasing risk of all-cause, cardiovascular, and noncardiovascular mortality with worse eGFR (all tests of trend p < 0.001). The lowest eGFR category (< 45 mL/min/1.73 m²) was associated with the highest risk of all-cause mortality (HR = 5.0, 95% CI = 2.4, 10), cardiovascular mortality (HR = 5.8, 95% CI = 1.8, 18), and noncardiovascular mortality (HR = 4.5, 95% CI = 1.9, 11). There was no significant association between CKD severity and MALE or minor revascularization events.

Conclusion

The risk of mortality risk after SFA endovascular revascularization incrementally increases with decreasing renal function. However, impaired renal function is not related to the risk of adverse limb events and supports femoral revascularization in these patients.

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外周动脉疾病的股动脉血管内重建术后慢性肾脏疾病、死亡率和主要不良肢体事件的风险：波士顿股动脉血管内重建术结果（波士顿FAROUT）研究

背景：慢性肾脏疾病（CKD）与外周动脉疾病（PAD）的预后较差相关。CKD严重程度对股浅动脉血管内重建术（SFA）后死亡率和主要肢体不良事件（MALE）的影响尚不清楚。目的：评估SFA血管内血运重建术后CKD严重程度增加与患者死亡和MALE风险的关系。方法：我们对2003年至2011年间在两个学术中心接受SFA血管内重建术治疗跛行或慢性肢体威胁缺血的202例患者（253条肢体）进行了随访。根据估计的肾小球滤过率（eGFR），将患者分为四种肾脏疾病改善总体结局（KDIGO）类别。主要结局是全因死亡。次要结局包括心血管死亡、非心血管死亡和男性死亡。通过病因特异性多变量Cox比例风险模型和Fine-Gray竞争风险分析的风险比（HR）和95%置信区间（95% ci）来评估CKD严重程度与结局之间的关系。结果：在中位9.3年的随访期间，eGFR较差的患者的全因、心血管和非心血管死亡风险逐渐增加（所有趋势试验均为p）。结论：SFA血管内血运重建术后的死亡风险随着肾功能的下降而增加。然而，肾功能受损与肢体不良事件的风险无关，并支持这些患者的股血运重建术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.

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