title: Long-term outcome of percutaneous transluminal angioplasty in chronic haemodialysis patients with peripheral arterial disease.
abstract: BACKGROUND
  Chronic haemodialysis patients are at an increased risk of peripheral artery disease (PAD). Although percutaneous transluminal angioplasty (PTA) has become a widely used therapeutic intervention for PAD, its outcome in haemodialysis patients remains poorly understood. The aim of this study was to clarify the long-term outcome of PTA as a primary treatment for PAD in haemodialysis patients.
  
  
  METHODS
  Consecutive 118 haemodialysis patients with 205 lesions and 108 non-haemodialysis patients with 143 lesions who underwent successful PTA as a first-choice therapeutic option for PAD were enrolled. Outcome measures included primary patency, limb salvage and survival.
  
  
  RESULTS
  Incidence of diabetes, history of coronary artery disease and femoropopliteal lesion were significantly more frequent in haemodialysis patients (P = 0.008, 0.005 and 0.0001, respectively), but critical limb ischaemia and TransAtlantic Inter-Society Consensus (TASC) lesion types occurred with comparable frequency in both groups. No patients had in-hospital complications. The 5-year primary patency, limb salvage and survival rates were significantly lower in haemodialysis patients (P = 0.01, 0.029 and 0.0024, respectively). On Cox multivariate analysis, haemodialysis was strongly predictive of amputation and all-cause death, but not of restenosis. In haemodialysis patients, TASC C+D lesion and ulceration/gangrene were independent predictors for restenosis and amputation.
  
  
  CONCLUSIONS
  The long-term outcome after PTA may be fully acceptable in haemodialysis patients who are at the highest risk of cardiovascular disease. PTA is a useful therapeutic strategy in haemodialysis patients with PAD, but PTA for TASC C+D lesions remains controversial.
authors.affiliation: Department of Cardiovascular Surgery, Cardiovascular Center, Nagoya Kyoritsu Hospital, Nagoya, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kumada
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishii
authors.forename: Miho
authors.initials: M
authors.lastname: Tanaka
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Takanobu
authors.initials: T
authors.lastname: Toriyama
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
authors.forename: Syoichi
authors.initials: S
authors.lastname: Maruyama
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome