title: Below-the-knee angioplasty in patients with end-stage renal disease.
abstract: OBJECTIVE
  To determine clinical efficacy of below-the-knee (BTK) angioplasty in patients with end-stage renal disease (ESRD).
  
  
  METHODS
  Interrogation of a prospectively maintained database containing 2,659 patients treated at a tertiary referral hospital between February 1995 and June 2004 identified 29 ESRD patients (21 men; median age 69 years, IQR 10.12) who had 73 infrapopliteal atherosclerotic lesions treated in 38 ischemic limbs. The indication for treatment was intermittent claudication in 13 (34%) and critical limb ischemia in 25 (66%) limbs. BTK angioplasty was attempted either alone (n=18) or combined with an endovascular inflow procedure (n=20). Primary clinical success was defined as hemodynamic improvement (ABI increase >or=0.1) and/or symptomatic improvement (at least one clinical category). Cumulative rates were calculated according to the Kaplan-Meier estimate.
  
  
  RESULTS
  Primary technical success reached 97%, whereas hemodynamic improvement was obtained in only 50% (19/38) of the limbs treated. The pedal arteries were severely diseased in all, and complete occlusion of the pedal arch was found in 58% (18/31) of limbs on completion angiography. Median follow-up was 5.9 months (IQR 11.5). Primary clinical success was 17%, 11%, 11%, and 11% in patients with BTK angioplasty alone and 53%, 45%, 45%, and 45% in patients with inflow procedures after 3, 6, 9, and 12 months, respectively (p=0.017). Limb salvage was 73% at 12 months. Subgroup analyses showed significantly better clinical results in men (p=0.003) and in patients on hemodialysis compared to peritoneal dialysis (p=0.037).
  
  
  CONCLUSIONS
  Clinical efficacy of BTK angioplasty is limited in patients with ESRD because of the severely diseased pedal arteries. Further studies are warranted to define subgroups of patients likely to experience a more favorable outcome.
authors.affiliation: Swiss Cardiovascular Center, Division of Angiology, Inselspital, University of Bern, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brosi
authors.forename: Iris
authors.initials: I
authors.lastname: Baumgartner
authors.forename: Antonio
authors.initials: A
authors.lastname: Silvestro
authors.forename: Dai-Do
authors.initials: DD
authors.lastname: Do
authors.forename: Felix
authors.initials: F
authors.lastname: Mahler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Triller
authors.forename: Nicolas
authors.initials: N
authors.lastname: Diehm
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D007866:Leg / Q000098:blood supply*; D008297:Male; D011150:Popliteal Artery; D011446:Prospective Studies; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014654:Vascular Patency