title: Beneficial Effect of Endovascular Therapy and Low-Density Lipoprotein Apheresis Combined Treatment in Hemodialysis Patients With Critical Limb Ischemia due to Below-Knee Arterial Lesions.
abstract: To assess the clinical benefit of combined treatment of below-knee endovascular therapy (BK-EVT) plus low-density lipoprotein apheresis (LDLA) compared with BK-EVT monotherapy, we retrospectively evaluated the clinical outcome of hemodialysis (HD) patients with critical limb ischemia (CLI) due to isolated BK arterial lesions who underwent BK-EVT or BK-EVT plus short-term LDLA. Between October 2011 and September 2014, 62 HD patients underwent isolated BK-EVT monotherapy (BK-EVT group), and 25 HD patients underwent BK-EVT plus LDLA (BK-EVT + LDLA group). LDLA was started within 1 week after BK-EVT and performed four times in total within next 2 weeks. Major adverse limb events (MALE) including major amputation and re-intervention, and all-cause mortality were examined by Kaplan-Meier method and the log-rank test. Baseline characteristics were not different other than low ABI and low dorsal SPP in BK-EVT + LDLA group. Cumulative MALE-free rate was significantly improved in BK-EVT + LDLA group over the BK-EVT group (72.0% and 45.1% respectively at 30 months after treatment, P = 0.04). All-cause mortality did not differ between the two groups. Major causes of death were heart failure and sepsis in both groups. Short-term LDLA hybrid treatment immediately after BK-EVT might improve the outcome of ischemic limbs after re-vascularization therapy.
authors.affiliation: Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Takayasu
authors.initials: T
authors.lastname: Ohtake
authors.affiliation: Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mochida
authors.affiliation: Department of Cardiology and Catheterization, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Matsumi
authors.affiliation: Department of Cardiology and Catheterization, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Tobita
authors.affiliation: Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Ishioka
authors.affiliation: Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Machiko
authors.initials: M
authors.lastname: Oka
authors.affiliation: Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Maesato
authors.affiliation: Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Moriya
authors.affiliation: Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Sumi
authors.initials: S
authors.lastname: Hidaka
authors.affiliation: Department of Cardiology and Catheterization, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
authors.affiliation: Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Shuzo
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001781:Blood Component Removal / Q000379:methods*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007511:Ischemia; D053208:Kaplan-Meier Estimate; D007866:Leg; D008077:Lipoproteins, LDL; D008297:Male; D058729:Peripheral Arterial Disease / Q000628:therapy*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D008077:Lipoproteins, LDL
keywords: Critical limb ischemia; Endovascular therapy; Hemodialysis; Low-density lipoprotein apheresis