In older patients with chronic kidney disease, surgical lower-extremity revascularization was associated with fewer survived days at home, but also with fewer days lost to major adverse limb events compared with an endovascular approach.
Surgical revascularization was associated with significantly fewer days at home at 30 days compared with endovascular revascularization.
Surgical revascularization was associated with fewer days at home at 180 days compared with endovascular revascularization.
Surgical revascularization was associated with fewer days at home at 365 days compared with endovascular revascularization.
Surgical revascularization was associated with fewer days lost to major adverse limb events at 180 days compared with endovascular revascularization.
Surgical revascularization was associated with fewer days lost to major adverse limb events at 365 days compared with endovascular revascularization.
The study population was predominantly older adults with chronic kidney disease who underwent endovascular rather than surgical revascularization.
This research examined older adults (age 66 and up) with chronic kidney disease who needed procedures to restore blood flow to their legs, comparing two approaches: open surgery and minimally invasive endovascular procedures. The study used Medicare data from nearly 87,500 patients treated between 2008 and 2017. Researchers measured two key outcomes that patients often care about differently: how many days patients spent at home (rather than in hospitals or other facilities), and how many days were lost due to serious limb complications like repeat procedures or amputations. The findings reveal a clear trade-off between the two approaches. Patients who had open surgery spent fewer days at home over the first year — about 32 fewer days compared to those who had the minimally invasive procedure. This suggests surgery involves a heavier short- and medium-term recovery burden. However, surgical patients also lost fewer days to serious limb complications — about 17 fewer days over the year — meaning their limbs fared better in terms of avoiding repeat procedures or amputations. This research suggests that neither approach is strictly better for older patients with chronic kidney disease — each involves different trade-offs that patients may weigh differently based on their own priorities. Someone who highly values avoiding hospitalizations and maximizing time at home might prefer the endovascular approach, while someone most concerned about long-term limb preservation might accept surgery's greater short-term burden. The authors emphasize that these findings support the importance of shared decision-making between patients and their healthcare providers when choosing between revascularization strategies.
Chang T, Parvathinathan G, Liu S, Lee J, Etemadi A, Arya S, et al.. (2026). Balancing Days at Home and Major Adverse Limb Events After Surgical Versus Endovascular Lower-Extremity Revascularization in Chronic Kidney Disease.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.048230