NDT Advance Access originally published online on January 31, 2007
Nephrology Dialysis Transplantation 2007 22(4):1144-1149; doi:10.1093/ndt/gfl764
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Percutaneous transluminal angioplasty is feasible and effective in patients on chronic dialysis with severe peripheral artery disease
1Servizio di Emodinamica, Istituto Clinico "Città di Brescia", Brescia, 2Unità di Diabetologia, Casa di Cura Clinica Castelli, Bergamo, 3Unità Operativa di Medicina e Oncologia, Istituti Ospedalieri di Cremona, Cremona, 4Unità di Medicina Interna, Spedali Civili di Brescia, Brescia, 5Sezione di Statistica Medica e Biometria, Università di Brescia, Brescia and 6Servizio UFA Nefrologia e Dialisi, Ospedale Val Camonica-Sebino, Esine, Italy
Correspondence and offprint requests to: Dr Lanfroi Graziani, Servizio di Emodinamica, Istituto Clinico Città di Brescia, Via Gualla 15, 25123 Brescia, Italy. Email: langrazi{at}tin.it
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Abstract |
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Background. Peripheral arterial disease (PAD) is common among patients on chronic dialysis. Despite severe clinical manifestations, the indication for bypass surgery is controversial, because of the high morbidity and mortality rate of these patients. The less invasive percutaneous transluminal angioplasty (PTA) is a possible alternative, but data about PTA in dialysis patients are scarce.
Methods. We followed 107 dialysis patients (mean age 67 ± 10, 75 males) with 132 ischaemic limbs (97% with critical limb ischaemia and ischaemic foot lesions or rest pain) consecutively treated by PTA.
Results. PTA was successful in 97% of cases. Median follow-up was 22 months. Cumulative limb salvage rates at 12, 24, 36 and 48 months were 86, 84, 84 and 62%, respectively. Log-rank test showed an association between major amputation and baseline presence of foot lesions (P = 0.04). This association was confirmed by a Cox survival multivariate analysis [hazard ratio (HR) = 7.03, 95% confidence interval (CI) = 1.1–43.0, P = 0.035]. Limb salvage without any new intervention on the same leg was achieved in 70% of the cases, and was associated with the absence of diabetes mellitus (P = 0.01), lower number of treated lesions (P = 0.04) and proximal level (iliac and/or femoro–popliteal) of PTA (P < 0.001). Independent predictors were diabetes mellitus (HR = 3.47, 95% CI = 1.31–9.17, P = 0.01) and proximal PTA (HR = 0.28, 95% CI = 0.08–0.94, P = 0.04). Fifty-three (49%) patients died during follow-up. Patients older than 67 years (the median value in our sample) had a 2.4-fold increase in mortality risk (95% CI = 1.4–4.1, P < 0.001).
Conclusions. PTA is feasible and effective in dialysis patients with PAD, and should be preferred to other more invasive interventions.
Keywords: critical limb ischaemia; dialysis; end-stage renal disease; percutaneous transluminal angioplasty; peripheral artery disease
Received for publication: 2. 8.06
Accepted in revised form: 22.11.06
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