Chronic hemodialysis (HD) patients are at an increased risk for peripheral artery disease (PAD). Although percutaneous transluminal angioplasty (PTA) has become a widely used therapeutic intervention for PAD, its outcome in HD patients remains poorly understood. The aim of this study was to clarify the long-term outcome after PTA in HD patients with PAD. Consecutive 241 HD patients with 418 lesions and 152 non-HD patients with 201 lesions who underwent successful PTA as a first-choice therapeutic option for PAD were enrolled. They were followed for 8 years. Outcome measures included target lesion revascularization (TLR), major amputation, and all-cause mortality. Mean age was younger and prevalence of coronary artery disease and femoropopliteal lesion were significantly more frequent in HD patients (66±10years vs. 71±10years, p=0.0001, 52% vs. 41%, p=0.035 and 71% vs. 52%, p=0.0002, respectively). Prevalence of critical limb ischemia and TASC C+D lesion types were comparable in both groups (45% vs. 34% and 37% vs. 38%, respectively). During 46±38months, the 8-year freedom from TLR (64% vs. 76%, p=0.0057) limb salvage (82% vs. 97%, p=0.0001) and survival rates (52% vs. 87%, p<0.0001) were significantly lower in HD patients, respectively. On Cox multivariate analysis, HD status was strongly predictive of major amputation (HR 4.69, 95%CI 1.34 –16.39, p=0.015) and all-cause death (HR 5.13, 95%CI 2.14 –12.35, p=0.0002) but not of TLR (HR 1.54, 95%CI 0.85–2.78, p=0.15). In HD patients, ulceration/gangrene were independent predictors for all outcome (HR 2.50, 95%CI 1.22–5.09, p=0.0003 for TLR, HR 6.71, 95%CI 2.78 –16.13, p<0.0001 for amputation, and HR 1.95, 95%CI 1.11– 4.20, p=0.017 for all-cause death, respectively). Additional stenting was an independent predictor to reduce TLR in HD patients (HR 0.51, 95%CI 0.28 – 0.94, p=0.031). The long-term outcome after PTA was still poorer in HD patients compared with non-HD patients, but it might be acceptable in HD patients. Ulceration/gangrene was deeply associated with any outcome, thus, the detection at the earlier stage of PAD is important in this population who are at the highest risk for arteriosclerosis. Additional stenting was useful to reduce TLR.
Long-term outcome of percutaneous transluminal angioplasty in chronic haemodialysis patients with peripheral arterial disease
