Endovascular treatment of lower extremity ischemia in chronic renal failure patients on dialysis: early and intermediate term results.
BACKGROUND
Peripheral arterial occlusive disease is common in patients with chronic renal failure requiring dialysis. Despite the increasing use of endovascular revascularization for lower extremity ischemia, the success rates of treating lower extremity ischemia in this challenging population remain obscure.


OBJECTIVE
To assess the results of endovascular revascularization for lower extremity ischemia in dialysis patients.


METHODS
We conducted a retrospective review of all dialysis patients who underwent endovascular treatment for critical limb ischemia (CLI) in our institution between 2007 and 2011. Data collected included comorbidities, clinical presentation, anatomic distribution of vascular lesions, amputation and survival rates.


RESULTS
We identified 50 limbs (41 patients). Indications included gangrene in 22%, non-healing wounds in 45%, rest pain in 31%, and debilitating claudication in 4%. Mean follow-up was 12 months (1-51 months). Nineteen patients required amputations. Freedom from amputation at 5 years was 40%. Factors associated with amputation included non-healing wounds or gangrene (68% and 36% respectively) and diabetes (P < 0.05). The survival rate was 80% after 5 years.


CONCLUSIONS
Despite improvement in endovascular techniques for lower extremity revascularization, the incidence of limb salvage among dialysis patients remains poor, resulting in a high rate of major amputations.
Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel. silverberg_d@msn.com
Daniel
D
Silverberg
Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel.
Tal
T
Yalon
Unit of Invasive Radiology, Sheba Medical Center, Tel Hashomer, Israel.
Uri
U
Rimon
Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel.
Emanuel R
ER
Reinitz
Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel.
Dmitry
D
Yakubovitch
Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel.
Jacob
J
Schneiderman
Unit of Invasive Radiology, Sheba Medical Center, Tel Hashomer, Israel.
Moshe
M
Halak
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000792:Angiography / Q000379:methods; D001158:Arteries / Q000601:surgery*; D015897:Comorbidity; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology; D007677:Kidney Function Tests; D023821:Limb Salvage / Q000706:statistics & numerical data; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000601:surgery; D015996:Survival Rate