NDT Advance Access published online on July 2, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn378
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Long-term outcome of percutaneous transluminal angioplasty in chronic haemodialysis patients with peripheral arterial disease
1 Department of Cardiovascular Surgery 2 Department of Cardiology, Cardiovascular Center, Nagoya Kyoritsu Hospital 3 Department of Cardiology 4 Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Correspondence and offprint requests to: Hideki Ishii, Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. Tel: +81-52-744-2147; Fax: +81-52-744-2210; E-mail: hkishii{at}med.nagoya-u.ac.jp
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Abstract |
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Background. Chronic haemodialysis patients are at an increased risk of peripheral artery disease (PAD). Although percutaneous transluminal angioplasty (PTA) has become a widely used therapeutic intervention for PAD, its outcome in haemodialysis patients remains poorly understood. The aim of this study was to clarify the long-term outcome of PTA as a primary treatment for PAD in haemodialysis patients.
Methods. Consecutive 118 haemodialysis patients with 205 lesions and 108 non-haemodialysis patients with 143 lesions who underwent successful PTA as a first-choice therapeutic option for PAD were enrolled. Outcome measures included primary patency, limb salvage and survival.
Results. Incidence of diabetes, history of coronary artery disease and femoropopliteal lesion were significantly more frequent in haemodialysis patients (P = 0.008, 0.005 and 0.0001, respectively), but critical limb ischaemia and TransAtlantic Inter-Society Consensus (TASC) lesion types occurred with comparable frequency in both groups. No patients had in-hospital complications. The 5-year primary patency, limb salvage and survival rates were significantly lower in haemodialysis patients (P = 0.01, 0.029 and 0.0024, respectively). On Cox multivariate analysis, haemodialysis was strongly predictive of amputation and all-cause death, but not of restenosis. In haemodialysis patients, TASC C+D lesion and ulceration/gangrene were independent predictors for restenosis and amputation.
Conclusions. The long-term outcome after PTA may be fully acceptable in haemodialysis patients who are at the highest risk of cardiovascular disease. PTA is a useful therapeutic strategy in haemodialysis patients with PAD, but PTA for TASC C+D lesions remains controversial.
Keywords: haemodialysis; peripheral artery disease; percutaneous transluminal angioplasty
Received for publication: 22. 2.08
Accepted in revised form: 12. 6.08