Poor Limb Prognosis of Patients with Chronic Limb-Threatening Ischemia on Hemodialysis: A Retrospective Observational Study Based on the Global Limb Anatomic Staging System

• Published in: Annals of vascular surgery Vol. 102; pp. 42 - 46
• Main Authors: Endo, Takashi, Takayama, Toshio, Miyahara, Kazuhiro, Shirasu, Takuro, Mochizuki, Yasuaki, Taniguchi, Ryosuke, Hoshina, Katsuyuki
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.05.2024
• Subjects: Chronic Disease; Chronic Limb-Threatening Ischemia; Endovascular Procedures; Humans; Ischemia - diagnostic imaging; Ischemia - surgery; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - therapy; Limb Salvage - methods; Lower Extremity - blood supply; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - therapy; Renal Dialysis - adverse effects; Retrospective Studies; Risk Factors; Treatment Outcome
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2023.11.049

The Global Limb Anatomic Staging System (GLASS) has been widely used to evaluate patients with chronic limb-threatening ischemia (CLTI). As end-stage kidney disease (ESKD) is a well-known CLTI risk factor, we aimed to determine whether patients on hemodialysis (HD) have a worse limb prognosis than those without ESKD, considering the same GLASS background. The data of 445 patients who underwent surgical and/or endovascular revascularization procedures for lower extremity ischemia were retrospectively collected in our division between 2005 and 2018. The major amputation rate and amputation-free survival (AFS) were compared between HD and non-HD patients. Among the 215 (48%) patients receiving HD, 58 limbs required major amputation (27% limb loss rate). Among the non-HD group, the limb loss rate was 13% (P < 0.0001). The overall AFS was significantly worse in patients receiving HD than those not (P < 0.0001). The AFS was significantly worse in HD patients when comparing GLASS-standardized subgroups. Patients with CLTI who were receiving HD had a worse limb prognosis than those not receiving, even when considering the same GLASS classification. Furthermore, there is a need for an ideal guideline focused on ESKD-directed peripheral artery disease. •ESKD patients on HD face worse limb outcomes from threat severity and lesion anatomy.•GLASS and WIfI systems aid revascularization plans but fail to distinguish ESKD impact.•ESKD impacts PAD guidelines, necessitating tailored treatment considerations.