Abstract | PURPOSE: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.
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Authors | Masatsugu Nakano, Keisuke Hirano, Osamu Iida, Yasutaka Yamauchi, Yoshimitsu Soga, Daizo Kawasaki, Junichi Tazaki, Kenji Suzuki, Masahiko Fujiwara, Terutoshi Yamaoka |
Journal | Annals of vascular surgery
(Ann Vasc Surg)
Vol. 29
Issue 6
Pg. 1225-34
(Aug 2015)
ISSN: 1615-5947 [Electronic] Netherlands |
PMID | 26004963
(Publication Type: Comparative Study, Journal Article, Multicenter Study)
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Copyright | Copyright © 2015 Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Aged, 80 and over
- Amputation, Surgical
- Angioplasty, Balloon
(adverse effects, mortality)
- Critical Illness
- Disease-Free Survival
- Female
- Humans
- Ischemia
(diagnosis, mortality, therapy)
- Japan
- Kaplan-Meier Estimate
- Limb Salvage
- Lower Extremity
(blood supply)
- Male
- Middle Aged
- Peripheral Arterial Disease
(diagnosis, mortality, therapy)
- Popliteal Artery
- Renal Dialysis
(adverse effects, mortality)
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Time Factors
- Treatment Outcome
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