Abstract 6053: Long-Term Outcome of Percutaneous Transluminal Angioplasty in Chronic Hemodialysis Patients with Peripheral Arterial Disease

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Toru Aoyama ◽  
Hideki Ishii ◽  
Miho Tanaka ◽  
Hiroshi Takahashi ◽  
Yoshihiro Kawamura ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Major Amputation ◽  
Transluminal Angioplasty ◽  
Chronic Hemodialysis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Artery Disease ◽  
Percutaneous Transluminal

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.

Percutaneous transluminal angioplasty of infrainguinal vein graft stenosis: Long-term outcome

1995 ◽  
Vol 82 (7) ◽  
pp. 1003-1004
Author(s):  
A. D. Houghton ◽  
M. R. Tyrrell ◽  
Y. Panayiotopoulos ◽  
J. F. Reidy ◽  
P. R. Taylor ◽  
...  
Keyword(s):  
Vein Graft ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Graft Stenosis ◽  
Percutaneous Transluminal

Long-term Outcome of Infrainguinal Percutaneous Transluminal Angioplasty

2004 ◽  
Vol 11 (3) ◽  
pp. 287-293 ◽  
Author(s):  
Carl-Magnus Wahlgren ◽  
Bo Kalin ◽  
Kent Lund ◽  
Jesper Swedenborg ◽  
Rabbe Takolander
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Percutaneous Transluminal

Percutaneous transluminal angioplasty of infrainguinal vein graft stenosis: Long—term outcome

1995 ◽  
Vol 82 (2) ◽  
pp. 204-206 ◽  
Author(s):  
P. Dunlop ◽  
K. Varty ◽  
T. Hartshorne ◽  
P. R. F. Bell ◽  
A. Bolia ◽  
...  
Keyword(s):  
Vein Graft ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Graft Stenosis ◽  
Percutaneous Transluminal

scholarly journals Percutaneous Transluminal Angioplasty for Atherosclerotic Stenoses of Intracranial Vessels

2004 ◽  
Vol 10 (2_suppl) ◽  
pp. 17-20 ◽  
Author(s):  
Y. Matsumaru ◽  
W. Tsuruta ◽  
T. Takigawa ◽  
A. Hyodo ◽  
H. Sato ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Cerebral Arteries ◽  
Transluminal Angioplasty ◽  
Morbidity Rate ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Middle Cerebral Arteries ◽  
Basilar Arteries ◽  
Percutaneous Transluminal

To study the efficacy and long-term outcome of percutaneous transluminal angioplasty (PTA) with/without stent placement for intracranial atherosclerotic stenoses, we reviewed our treated cases retrospectively. Between May 1992 and October 2003, PTA with/without stents was performed in 64 intracranial and skull base vessels in 62 patients, including 24 middle cerebral arteries, 16 internal carotid arteries, 13 vertebral arteries, and 11 basilar arteries. PTA was technically successful in 55 vessels (86%). However, four vessels (6%) failed to achieve satisfactory dilatation. We encountered five periprocedural strokes as symptomatic complications, for a mortality rate of 4.7% and a morbidity rate of 3.1%. All the patients with stent placements survived angioplasty without any complication. In the clinical follow-up available for one week to 11.5 years (mean, 4.7 years), there were three strokes related to the treated vessels. The annual stroke rate in the affected territory was estimated at 1.2% per year. According to these results, PTA for intracranial atherosclerotic stenoses seems to be a beneficial therapy for immediate anatomical results and long-term stroke prevention. Stent-assisted PTA could help patients achieve successful dilatation and avoid complications.

Abstract 3312: Cilostazol Improves Long-term Patency after Percutaneous Transluminal Angioplasty in Hemodialysis Patients with Peripheral Artery Disease

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Yoshitaka Kumada ◽  
Hideki Ishii ◽  
Toru Aoyama ◽  
Miho Tanaka ◽  
Takanobu Toriyama ◽  
...  
Keyword(s):  
Propensity Score ◽  
Peripheral Artery Disease ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Control Group ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Percutaneous Transluminal

Background: Percutaneous transluminal angioplasty (PTA) has become common therapeutic standard for peripheral artery disease (PAD). Although initial success rate of PTA is high, higher restenosis rate is a limitation in hemidialysis (HD) patients. Cilostazol is a PDE3 inhibitor with anti-platelet and vasodilatory effects, and also inhibits the proliferation of the smooth muscle cells, and has been reported to reduce target lesion revascularization (TLR) in PAD patients. The aim of this study was to clarify the effects of cilostazol administration for long-term patency after PTA in HD patients. Methods: Consecutive 372 lesions of 193 HD patients undergoing successfully PTA were enrolled. They were divided into two groups; patients administered cilostazol (130 lesions of 71 patients) and those without cilostazol as a control (242 lesions of 122 patients). They were followed-up using Doppler ultrasound and/or angiography for 5 years. To minimize the selection bias for cilostazol administration, a propensity-matched analysis using the model including male, age, diabetes, critical limb ischemia (CLI), TASC C+D type, femoropopoliteal (FPA) lesion and stenting was performed. The propensity score was matched 1:1 with two-digit (AUC=0.69 using ROC analysis). Results: Mean follow-up period was 28±24months. Primary patency rate for 5 years was significantly higher in the cilostazol group than in the control group (53% vs 33%, p = 0.0003). Also, rates for freedom from TLR and for limb salvage were higher in cilostazol group than in control group (67% vs. 50%, p=0.011 and 88% vs. 72%, p =0.031, respectively). In 102 lesions matched after propensity score analysis, the primary patency for 5-year was significantly higher in the cilostazol group (58%) than in the control group (35%) (HR 0.48, 95%CI 0.30 – 0.76, p = 0.0017). Upon multivariate Cox analysis, Cilostazol (HR 0.50, 95%CI 0.26 – 0.87, p = 0.014), age (HR 1.03, 95%CI 1.01–1.07, p = 0.041), FPA lesion (HR 2.62, 95%CI 1.22–5.62, p = 0.013), TASC C+D type (HR 2.85, 95%CI 1.56 –5.20, p = 0.0006) and CLI (HR 4.09, 95%CI 2.10 –7.94, p <0.0001) were independent predictors of restenosis after PTA. Conclusion: These data suggest that cilostazol administration improves long-term patency after PTA in HD Patients with PAD.

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