Clinical Efficacy of Infrapopliteal Endovascular Procedures for Hemodialysis Patients with Critical Limb Ischemia

• Published in: Annals of vascular surgery Vol. 29; no. 6; pp. 1225 - 1234
• Main Authors: Nakano, Masatsugu, Hirano, Keisuke, Iida, Osamu, Yamauchi, Yasutaka, Soga, Yoshimitsu, Kawasaki, Daizo, Tazaki, Junichi, Suzuki, Kenji, Fujiwara, Masahiko, Yamaoka, Terutoshi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.08.2015
• Subjects: Aged; Aged, 80 and over; Amputation; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - mortality; Critical Illness; Disease-Free Survival; Female; Humans; Ischemia - diagnosis; Ischemia - mortality; Ischemia - therapy; Japan; Kaplan-Meier Estimate; Limb Salvage; Lower Extremity - blood supply; Male; Middle Aged; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - mortality; Peripheral Arterial Disease - therapy; Popliteal Artery; Renal Dialysis - adverse effects; Renal Dialysis - mortality; Retrospective Studies; Risk Assessment; Risk Factors; Surgery; Time Factors; Treatment Outcome; Japan
• ISSN: 0890-5096; 1615-5947; 1615-5947
• DOI: 10.1016/j.avsg.2015.03.034

To investigate 5-year clinical outcomes after infrapopliteal endovascular therapy (EVT) for critical limb ischemia (CLI) patients on or not on hemodialysis (HD), and compare the clinical efficacy of EVT between the 2 groups. The subjects were 1091 CLI patients (1310 limbs) who underwent EVT for isolated infrapopliteal lesions from 2004 to 2012, and were classified into 2 groups for comparative study: the patients on HD group (670 patients, 830 limbs) and not on HD group (421 patients, 480 limbs). The HD group had a significantly lower rate of freedom from major adverse limb events or perioperative death (HD 78.4% vs. non-HD 86.0% at 1 year, HD 70.3% vs. non-HD 82.4% at 5 years, P = 0.01), or amputation-free survival (AFS) rate (HD 65.7% vs. non-HD 78.7% at 1 year, HD 34.4% vs. non-HD 59.8% at 5 years, P < 0.01) after EVT compared with the non-HD group. Independent predictors of AFS in HD patients were nonambulatory, diabetes mellitus, albumin <3.0 g/dL, ejection fraction ≤0.48, and no patent pedal arch arteries before EVT. AFS at 1 year was 81% in patients with 0 or 1 predictor, surpassing the suggested AFS objective performance goal (OPG) end points of 68%, but AFS in patients with 2 or more predictors failed to reach the OPG. In comparison with non-HD patients, the clinical efficacy of infrapopliteal EVT for HD patients was poor. Preoperative risk stratification based on AFS predictors can be used as an index for predicting the prognosis.