title: Prognosis of critical limb ischemia in hemodialysis patients after isolated infrapopliteal balloon angioplasty: results from the Japan below-the-knee artery treatment (J-BEAT) registry.
abstract: OBJECTIVE
  To evaluate the long-term clinical results after isolated infrapopliteal balloon angioplasty for critical limb ischemia (CLI) in end-stage renal disease patients on hemodialysis.
  
  
  METHODS
  Between April 2004 and October 2010, 406 CLI consecutive patients (275 men; mean age 71±11 years) who underwent balloon angioplasty for primary treatment of isolated infrapopliteal artery lesions in 465 limbs were enrolled in a multicenter, non-randomized registry. The patients were classified into 2 groups, those on hemodialysis (242 patients with 283 limbs) and those not (164 patients with 182 limbs), for a retrospective comparative study of clinical outcomes [target extremity revascularization (TER), major amputation (MA), and survival] at an average 3.4±1.9 years.
  
  
  RESULTS
  Freedom from TER at 5 years was lower in the hemodialysis patients (48.3% vs. 65.4% in non-hemodialysis patients, p<0.001); 9.9% of hemodialysis patients had undergone bypass surgery in contrast to 3.8% of non-hemodialysis patients (p=0.011). Freedom from MA was 77.1% in hemodialysis patients and 85.1% in non-hemodialysis patients at 5 years (p=0.058). Hemodialysis patients had significantly poorer survival (24.3% vs. 48.0%, p<0.001) and MA-free survival (20.8% vs. 42.9%, p<0.001) than non-hemodialysis patients at 5 years. Multivariate predictors of MA or all-cause death were non-ambulatory status (p<0.001), gangrene (p=0.036), and higher C-reactive protein levels (p=0.048).
  
  
  CONCLUSIONS
  Although hemodialysis patients have a higher TER rate compared to the general population, the long-term limb salvage rate after balloon angioplasty for isolated infrapopliteal lesions is acceptable; nevertheless, the MA-free survival rate is very low.
authors: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan. m_nakano@tobu.saiseikai.or.jp
authors: Masatsugu
authors: M
authors: Nakano
authors: Keisuke
authors: K
authors: Hirano
authors: Osamu
authors: O
authors: Iida
authors: Yoshimitsu
authors: Y
authors: Soga
authors: Daizo
authors: D
authors: Kawasaki
authors: Kenji
authors: K
authors: Suzuki
authors: Yusuke
authors: Y
authors: Miyashita
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007564:Japan; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D011150:Popliteal Artery; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies