[Prevention and therapy of critical ischemia in hemodialyzed patients].
The cardiovascular disease is largely increased in chronic renal failure and the patients have a 10-20 times higher mortality respect normal population. Besides habitual risk-factors they add the mineral metabolism alterations, iperomocisteine and chronical vessel flogosis. In these patients the vascular disease is often lately diagnosed, but early diagnosis would be extremely important to establish appropriate pharmacologic or surgical treatment (PTA or by pass). The basic diagnostic methods are still digital angiography, angio-NMR or angio-CT. In our experience appears that dialysed patients present high total mortality and re-vascolarization (particularly for peripheral occlusive disease) gives less guarantee of success. During last years endovascular surgery procedures extremely improved short-term prognosis for these patients. When there is no space for the re-vascolarization and the situation is strongly compromised by the presence of extended gangrene or infected lesion, amputation is still indicated and can be considered the only possible solution.
Andreoli
M
M
Strutture Complesse di Chirurgia Vascolare, Azienda Ospedaliera C. Poma, Mantova 46100, Italy.
Galli
G
G
Arienzo
A
A
Nora
A
A
Tedoli
M
M
Guidetti
D
D
Pacchioni
R
R
Ferrari
G
G
Talassi
E
E
Serra
A
A
Tarchini
R
R
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000150:complications; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000517:prevention & control / Q000628:therapy*; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods