Abstract 12419: Prognostic Factors of Hemodialysis Patients Undergoing Endovascular Treatments for Critical Limb Ischemia due to Isolated Infra-Popliteal Disease
Background: There is avid debate in management of peripheral arterial disease (PAD) among hemodialysis patients due to poor rates of both limb and patient survival. Endovascular treatment (EVT) for PAD is performed more routinely, and has similar outcomes as compared to bypass surgery in terms of amputation-free survival rate among patients with critical limb ischemia (CLI) due to infra-inguinal disease. However, the long-term patency of EVT in infra-popliteal disease is still unfavorable. The purpose of this study is to clarify the effectiveness of EVT and to investigate prognostic factors in the management of hemodialysis patients with CLI due to isolated infra-popliteal disease.
Materials and Methods: A total of 546 hemodialysis patients who underwent EVT for CLI with isolated infra-popliteal disease at 11 hospitals in Japan between March 2004 and June 2011 were retrospectively analyzed.
Results: Average patient age was 69.1 years (range 38 to 97) and 420 (74.6%) were male. The number of patients classified to Rutherford stage 4, 5, and 6, was 103 (18.9%), 332 (60.8%), and 111 (20.3%), respectively. 223 (40.8%) had HbA1c level >6.5%, and 195 (35.7%) were active smokers. During the follow-up period (mean: 557.5 days), 191 (35.0%) died and 67 (12.3%) underwent a major amputation. Cox proportional hazard regression analyses revealed that non-ambulatory state (1.82 [1.31-2.52], p<0.01), body mass index (0.94 [0.89-0.99] p<0.05), serum albumin level (0.57 [0.42-0.79], p<0.01), and diabetes mellitus (0.60 [0.44-0.83], p<0.01), left ventricular ejection fraction (0.98 [0.97-0.99] p<0.01), and number of infra-popliteal runoff vessels after EVT (0.82 [0.70-0.97], p<0.05), were significant prognostic factors of overall mortality, and that age (0.97 [0.94-0.99], p<0.01), non-ambulatory state (2.18 [1.27-3.75], p<0.01), Rutherford classification stage 6 (4.83 [1.63-14.3], p<0.01), and number of infra-popliteal runoff vessels after EVT (0.73 [0.55-0.98], p<0.05), were significant predictors for major amputation.
Conclusions: Although the prognosis of limb and patient survival among those on hemodialysis with CLI is still poor, this study will help guide treatment decisions regarding EVT, bypass surgery, or major amputation.
- © 2012 by American Heart Association, Inc.