• Pranav S Garimella, Poojitha Balakrishnan, Ashish Correa, Priti Poojary, Narender Annapureddy, Kinsuk Chauhan, Achint Patel, Shanti Patel, Ioannis Konstantinidis, Lili Chan, Shiv Kumar Agarwal, Bernard G Jaar, Umesh Gidwani, Kunihiro Matsushita, and Girish N Nadkarni.
• Division of Nephrology-Hypertension, University of California-San Diego, San Diego, California. Electronic address: pgarimella@ucsd.edu.
• JACC Cardiovasc Interv. 2017 Oct 23; 10 (20): 2101-2110.

ObjectivesThis study 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 hospitalized for peripheral artery disease (PAD).BackgroundPAD 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 post-procedure outcomes in this population.MethodsWe used the Nationwide Inpatient Sample (2002 to 2012) to identify hemodialysis patients undergoing endovascular or surgical procedures for PAD using diagnostic and procedural codes. We compared trends in amputation, post-procedure complications, mortality, length of stay, and costs between the 2 groups using trend tests and logistic regression.ResultsThere were 77,049 endovascular and 29,556 surgical procedures for PAD in hemodialysis patients. Trend analysis showed that endovascular procedures increased by nearly 3-fold, whereas there was a reciprocal decrease in surgical revascularization. Post-procedure complication rates were relatively stable in persons undergoing endovascular procedures but nearly doubled in those undergoing surgery. Surgery was associated with 1.8 times adjusted odds (95% confidence interval: 1.60 to 2.02) for complications and 1.6 times the adjusted odds for amputations (95% confidence interval: 1.40 to 1.75) but had similar mortality (adjusted odds ratio: 1.05; 95% confidence interval: 0.85 to 1.29) compared with endovascular procedures. Length of stay for endovascular procedures remained stable, whereas a decrease was seen for surgical procedures. Overall costs increased marginally for both procedures.ConclusionsRates 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.Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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