Nationwide Trends and Hospital Outcomes of Revascularization Studied in PAD Patients With End-Stage Renal Disease on Hemodialysis
October 19, 2017—A study that aimed to describe the temporal trends and outcomes of endovascular and surgical revascularization in a large, nationally representative sample of patients with end-stage renal disease on hemodialysis who were hospitalized for peripheral artery disease (PAD), was published by Pranav S. Garimella, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2017;10:2101–2110).
The background of the study is that although PAD is prevalent among patients with end-stage renal disease on hemodialysis and is associated with significant morbidity and mortality, there is a paucity of information on trends in endovascular and surgical revascularization and postprocedure outcomes in this population.
As summarized in JACC: Cardiovascular Interventions, the Nationwide Inpatient Sample (2002 to 2012) was used to identify hemodialysis patients undergoing endovascular or surgical procedures for PAD using diagnostic and procedural codes. The investigators compared trends in amputation, postprocedure complications, mortality, length of stay, and costs between the two groups using trend tests and logistic regression.
The investigators reported that there were 77,049 endovascular and 29,556 surgical procedures for PAD in hemodialysis patients. Trend analysis showed that endovascular procedures increased by nearly threefold, whereas there was a reciprocal decrease in surgical revascularization.
Postprocedure complication rates were relatively stable in patients undergoing endovascular procedures but approximately doubled in those patients undergoing surgery. Surgery was associated with 1.8 times the adjusted odds for complications (95% confidence interval [CI], 1.6 to 2.02) and 1.6 times the adjusted odds for amputations (95% CI, 1.4 to 1.75), but had similar mortality (adjusted odds ratio, 1.05; 95% CI, 0.85 to 1.29) compared with endovascular procedures.
Additionally, the length of stay for endovascular procedures remained stable, whereas a decrease was seen for surgical procedures. Overall costs increased marginally for both procedures.
The investigators concluded that rates of endovascular procedures have increased, whereas those of surgeries have decreased; surgical revascularization is associated with higher odds of overall complications. Further prospective studies and clinical trials are required to analyze the relationship between the severity of PAD and the revascularization strategy chosen, advised the investigators in JACC: Cardiovascular Interventions.