title: Endovascular management of critical limb ischemia in renal transplant patients.
abstract: BACKGROUND
  End-stage renal disease is a significant negative predictor of limb salvage and patient survival in patients with limb ischemia, but little is known of the overall effects of renal transplantation. Endovascular management may be less morbid than open surgery, but technical success and durability in these patients is not well established.
  
  
  METHODS
  All patients with functioning renal transplants and critical limb ischemia (CLI) treated with endovascular techniques between 2003 and 2010 were retrospectively reviewed for limb salvage, reintervention, pre- and postprocedure creatinine, and estimated glomerular filtration rate (eGFR), and overall survival. Contralateral common femoral access, low-profile techniques, and isosmolar contrast were standard for all interventions.
  
  
  RESULTS
  Endovascular interventions were performed on 57 limbs in 28 patients with renal transplants. Mean age was 54 years, 78% were male, 85% were diabetic, 100% were hypertensive, and 64% had a positive smoking history. All patients were treated for CLI. Treated regions included 16 iliac, 19 superficial femoral, 16 popliteal, and 12 tibial arteries, as well as 1 bypass graft with initial technical success of 100% and 0% 30-day mortality. Of all lesions, 43% required reintervention during the follow-up period, the majority in the first year. There was no significant change in eGFR or creatinine comparing pre- and post-angiogram value. Limb salvage and 1-year survival were 83% and 82%, respectively.
  
  
  CONCLUSIONS
  Endovascular management of CLI in renal transplant patients results in good technical success and can be accomplished without a measurable change in transplant kidney function, although it requires repeat interventions. Endovascular therapy is a reasonable first-line treatment option for this high-risk group.
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Denis
authors.initials: D
authors.lastname: Gilmore
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Martin
authors.initials: M
authors.lastname: Dib
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Amy
authors.initials: A
authors.lastname: Evenson
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Marc
authors.initials: M
authors.lastname: Schermerhorn
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Mark
authors.initials: M
authors.lastname: Wyers
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Chaikof
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: ahamdan@bidmc.harvard.edu.
authors.forename: Allen
authors.initials: A
authors.lastname: Hamdan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine