title: Combination treatment using percutaneous transluminal angioplasty and low-density lipoprotein apheresis in a patient with peripheral arterial disease and a history of chronic hemodialysis.
abstract: Peripheral arterial disease (PAD) is very common in dialysis patients, who tend to have diffuse calcification and severe peripheral arterial stenosis that make it difficult to treat limbs using only surgical or endovascular interventions. Better ways to treat this condition are therefore required and also follow-up studies to evaluate the effects of these treatments on the microcirculation. A 59-year-old man who had a cadaveric kidney transplant five years previously after 25 years of regular hemodialysis complained of pain at rest in his right lower limb and subsequently developed an intractable decubitus ulcer on his right fifth toe (Fontaine IV). Digital subtraction angiography revealed a severe obstruction of the right femoral artery and diffuse stenosis of the right superficial femoral artery. The patient underwent percutaneous transluminal angioplasty (PTA) and six sessions of low-density lipoprotein apheresis (LDL apheresis). At the end of these sessions his complaints were almost completely alleviated. The mean elevation in skin temperature after each session was (1.58 ± 0.99)°C [mean ± SD] over the right dorsalis pedis artery and (1.52 ± 0.88)°C at the tip of the right fifth toe. Ultrasound-measured blood flow rates in the right dorsalis pedis artery were 9.2 cm/s before PTA and 20.2 cm/s one month after PTA. Hemodialysis was resumed 3 days after the PTA due to contrast-induced nephropathy. The combination of PTA and LDL apheresis is useful for treating PAD in hemodialysis patients, with the changes in peripheral artery patency are able to be evaluated effectively by measuring skin temperature.
authors: Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors: Hiroaki
authors: H
authors: Nishimura
authors: Hideki
authors: H
authors: Enokida
authors: Masafumi
authors: M
authors: Tsuruta
authors: Yuji
authors: Y
authors: Yoshino
authors: Yasutoshi
authors: Y
authors: Yamada
authors: Satoshi
authors: S
authors: Sugita
authors: Sadao
authors: S
authors: Hayashi
authors: Kenichi
authors: K
authors: Arata
authors: Hiroshi
authors: H
authors: Hayami
authors: Kenryu
authors: K
authors: Nishiyama
authors: Masayuki
authors: M
authors: Nakagawa
mesh_terms: D017130:Angioplasty; D001781:Blood Component Removal; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000503:physiopathology / Q000628:therapy*; D006435:Renal Dialysis; D012881:Skin Temperature
chemical_list: D008077:Lipoproteins, LDL
keywords: chronic dialysis; low-density lipoprotein apheresis; percutaneous transluminal angioplasty; peripheral arterial disease