Renal insufficiency is associated with an increased incidence of poor
outcomes, including cardiovascular events and death, in the general
population. Renal dysfunction appears to have a particularly negative
impact in patients undergoing vascular surgery and endovascular therapy.
Although the exact mechanism is unknown, increased levels of
inflammatory and biochemical modulators associated with adverse
cardiovascular outcomes, as well as endothelial dysfunction, appear to
play a role in the association between renal insufficiency and adverse
outcomes. Outcomes after the surgical and endovascular treatment of
abdominal aortic aneurysms, carotid disease, and peripheral arterial
disease are all negatively affected by renal insufficiency. Patients
with renal dysfunction may warrant intervention for the treatment of
critical limb ischemia and symptomatic carotid stenosis, given the
comparatively worse outcomes associated with medical management. Open
repair of aortic aneurysms and carotid intervention for asymptomatic
disease in patients with severe renal dysfunction should be performed
with significant caution, as the risks of repair may outweigh the
benefits in this population. Further study is needed to better delineate
the risks of medical management for these conditions in patients with
coexisting severe renal dysfunction.
Lastly, current guidelines for the
management of vascular diseases, including objective performance goals
for critical limb ischemia, are likely not applicable in patients with
severe renal insufficiency.
Stages of chronic kidney disease.
| CKD stage | Description | GFR (mL/min/1.73 m2) |
|---|
| I | Normal or mildly decreased GFR | ≥90 |
| II | Normal or mildly decreased GFR | 60−89 |
| III | Moderately decreased GFR | 30−59 |
| IV | Severely decreased GFR | 15−29 |
| V | Severely decreased GFR | <15 td=""> | |
|
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http://www.semvascsurg.com/article/S0895-7967%2815%2900007-1/fulltext
