Masatsugu Nakano1, Keisuke Hirano2, Osamu Iida3, Yasutaka Yamauchi4, Yoshimitsu Soga5, Daizo Kawasaki6, Junichi Tazaki7, Kenji Suzuki8, Masahiko Fujiwara9, Terutoshi Yamaoka10. 1. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan. Electronic address: m_nakano@tobu.saiseikai.or.jp. 2. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan. 3. Department of Cardiology, Kansai Rosai Hospital, Amagasaki, Japan. 4. Department of Cardiology, Kikuna Memorial Hospital, Yokohama, Japan. 5. Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan. 6. Department of Cardiology, Morinomiya Hospital, Osaka, Japan. 7. Department of Cardiology, Kyoto University Hospital, Kyoto, Japan. 8. Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan. 9. Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan. 10. Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.
Abstract
PURPOSE: To investigate 5-year clinical outcomes after infrapopliteal endovascular therapy (EVT) for critical limb ischemia (CLI) patients on or not on hemodialysis (HD), and compare the clinical efficacy of EVT between the 2 groups. METHODS: The subjects were 1091 CLI patients (1310 limbs) who underwent EVT for isolated infrapopliteal lesions from 2004 to 2012, and were classified into 2 groups for comparative study: the patients on HD group (670 patients, 830 limbs) and not on HD group (421 patients, 480 limbs). RESULTS: The HD group had a significantly lower rate of freedom from major adverse limb events or perioperative death (HD 78.4% vs. non-HD 86.0% at 1 year, HD 70.3% vs. non-HD 82.4% at 5 years, P = 0.01), or amputation-free survival (AFS) rate (HD 65.7% vs. non-HD 78.7% at 1 year, HD 34.4% vs. non-HD 59.8% at 5 years, P < 0.01) after EVT compared with the non-HD group. Independent predictors of AFS in HD patients were nonambulatory, diabetes mellitus, albumin <3.0 g/dL, ejection fraction ≤0.48, and no patent pedal arch arteries before EVT. AFS at 1 year was 81% in patients with 0 or 1 predictor, surpassing the suggested AFS objective performance goal (OPG) end points of 68%, but AFS in patients with 2 or more predictors failed to reach the OPG. CONCLUSIONS: In comparison with non-HD patients, the clinical efficacy of infrapopliteal EVT for HD patients was poor. Preoperative risk stratification based on AFS predictors can be used as an index for predicting the prognosis.
PURPOSE: To investigate 5-year clinical outcomes after infrapopliteal endovascular therapy (EVT) for critical limb ischemia (CLI) patients on or not on hemodialysis (HD), and compare the clinical efficacy of EVT between the 2 groups. METHODS: The subjects were 1091 CLI patients (1310 limbs) who underwent EVT for isolated infrapopliteal lesions from 2004 to 2012, and were classified into 2 groups for comparative study: the patients on HD group (670 patients, 830 limbs) and not on HD group (421 patients, 480 limbs). RESULTS: The HD group had a significantly lower rate of freedom from major adverse limb events or perioperative death (HD 78.4% vs. non-HD 86.0% at 1 year, HD 70.3% vs. non-HD 82.4% at 5 years, P = 0.01), or amputation-free survival (AFS) rate (HD 65.7% vs. non-HD 78.7% at 1 year, HD 34.4% vs. non-HD 59.8% at 5 years, P < 0.01) after EVT compared with the non-HD group. Independent predictors of AFS in HDpatients were nonambulatory, diabetes mellitus, albumin <3.0 g/dL, ejection fraction ≤0.48, and no patent pedal arch arteries before EVT. AFS at 1 year was 81% in patients with 0 or 1 predictor, surpassing the suggested AFS objective performance goal (OPG) end points of 68%, but AFS in patients with 2 or more predictors failed to reach the OPG. CONCLUSIONS: In comparison with non-HDpatients, the clinical efficacy of infrapopliteal EVT for HDpatients was poor. Preoperative risk stratification based on AFS predictors can be used as an index for predicting the prognosis.