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Bypass surgery and endovascular therapy performed similarly well for patients with critical limb ischemia who were on chronic hemodialysis, a Japanese study suggested.

There was between recipients of surgery and endovascular therapy through up to 8 years of follow-up (adjusted HR 1.14, 95% CI 0.83-1.58). The cumulative incidence of amputation or death was 52.9% in the bypass group and 64.2% in the stented group.

Further attempts at revascularization were less common in the bypass group in the long run, however (21.5% versus 51.7, P<0.0001), reported , of Matsunami General Hospital in Japan, and colleagues, in a letter published in the Journal of the American College of Cardiology.

The BASIL study previously showed that patients with chronic kidney disease did equally well after surgery or angioplasty; the current investigation included the most severe patients on hemodialysis.

Ishii's retrospective study reviewed the charts of 566 consecutive patients who underwent revascularization for 613 limbs at two Japanese centers. Bypass surgery was performed in 234 patients (248 limbs); another 332 individuals (365 limbs) got endovascular therapy.

At baseline, the bypass surgery group presented with more tissue loss (89.7% versus 55.1% for stented arm, P<0.0001) and infrapopliteal disease (57.3% versus 27.1%, P<0.0001). This cohort also had higher serum C-reactive protein levels (median 22.0 versus 7.0 mg/L, P<0.0001).

The authors conducted propensity score adjustment to minimize the characteristics differences, but they acknowledged the potential for residual confounding. Of note, critical limb ischemia might potentially have been misclassified because the group only referenced Fontaine classifications on patients' chart reviews.

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