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Ann Vasc Surg. 2018 Jan;46:118-126. doi: 10.1016/j.avsg.2017.04.006. Epub 2017 May 4.

Outcomes of Isolated Tibial Endovascular Intervention for Rest Pain in Patients on Dialysis.

Author information

1
Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Center for Vascular Care, University Hospital System, San Antonio, TX.
2
Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Center for Vascular Care, University Hospital System, San Antonio, TX. Electronic address: daviesm@uthscsa.edu.

Abstract

BACKGROUND:

Tibial interventions for critical limb ischemia are frequent in patients with end-stage renal disease (ESRD) presenting with critical ischemia. The aim of this study was to examine impact of ESRD on the patient-centered outcomes following tibial endovascular Intervention for rest pain.

METHODS:

A database of patients undergoing lower extremity endovascular interventions between 2006 and 2016 was retrospectively queried. Patients with rest pain (Rutherford 4) were identified. Patients with claudication (Rutherford 1 to 3) and tissue loss (Rutherford 5 and 6) were excluded. Patients were categorized by the presence or absence of ESRD. Patient-orientated outcomes of clinical efficacy (CE; absence of recurrent symptoms, maintenance of ambulation, and absence of major amputation), amputation-free survival (AFS; survival without major amputation), and freedom from major adverse limb events (MALEs; above ankle amputation of the index limb or major reintervention new bypass graft, jump/interposition graft revision) were evaluated.

RESULTS:

A total of 829 patients (56% male, average age 59 years; 658 nonhemodialysis [non-HD] and 171 HD) underwent isolated tibial intervention in one leg for rest pain. Technical success was 99% with a median of 2 vessels treated per patient. There was no difference in the distribution of Trans-Atlantic Inter-Society Consensus I lesions, but both the modified Society for Vascular Surgery (SVS) runoff score and the pedal runoff score were worse in the HD group. The 30-day major adverse cardiac events and 30-day MALEs were equivalent in both groups. CE was 38 ± 9% and 19 ± 8% at 5 years for the non-HD and HD groups, respectively (P < 0.01). Overall, AFS was 45 ± 8% and 18 ± 9% at 5 years for the non-HD and HD groups, respectively (P < 0.01). Freedom from MALE was 41 ± 9% and 21 ± 8% at 5 years for the non-HD and HD groups, respectively (P < 0.01).

CONCLUSIONS:

Patients with ESRD who present with rest pain have equivalent short-term outcomes to those not on dialysis but do not achieve long-term satisfactory CE and AFS after isolated tibial intervention for rest pain.

PMID:
28479421
DOI:
10.1016/j.avsg.2017.04.006
[Indexed for MEDLINE]

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