title: Prognostic Factors in Hemodialysis Patients Undergoing Endovascular Treatment for Critical Limb Ischemia due to Isolated Below-the-Knee Disease.
abstract: OBJECTIVE
  To investigate the prognosis and to clarify the predictors of both patient and limb survival among hemodialysis (HD) patients with critical limb ischemia (CLI) due to isolated below-the-knee (BK) disease.
  
  
  METHODS
  An observational cohort study, analyzing a total of 546 HD patients with 681 limbs who underwent endovascular treatment (EVT) for CLI with isolated BK disease at 11 hospitals in Japan between March 2004 and June 2011, was performed.
  
  
  RESULTS
  The mean patient age was 69.0±9.5 years, and 420 (76.9%) of the subjects were men. The number of patients classified with Rutherford stage 4, 5 and 6 disease was 103 (18.9%), 332 (60.8%) and 111 (20.3%), respectively. The mean HbA1c level was 6.48±1.20%, and 195 (35.7%) of the subjects were active smokers. During the follow-up period (mean: 557.5 days), 191 (35.0%) patients died and 82 (12.0%) limbs underwent major amputation. The freedom from all-cause death was 75.5%, 53.4% and 36.9% and freedom from major amputation was 86.7%, 83.9% and 83.9% at one, three and five years after EVT, respectively. Cox proportional hazard regression analyses revealed that a non-ambulatory status, low serum albumin level and ＜2 runoff vessels after EVT were significant predictors for both all-cause death and major amputation.
  
  
  CONCLUSIONS
  Although patient survival remains poor, the limb salvage rate after EVT is favorable among those on HD with CLI due to isolated BK disease. The present results allow for the risk stratification of HD patients with CLI undergoing EVT for isolated BK disease.
authors.affiliation: Department of Cardiology, Japanese Red Cross Fukuoka Hospital.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Suematsu
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Takahara
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Yamauchi
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Soga
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Nakano
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.forename: Daizo
authors.initials: D
authors.lastname: Kawasaki
authors.forename: Terutoshi
authors.initials: T
authors.lastname: Yamaoka
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shintani
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miyashita
authors.forename: Junichi
authors.initials: J
authors.lastname: Tazaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Meno
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Inou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D007564:Japan; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D015415:Biomarkers