Tratamento endovascular da isquemia crónica dos membros inferiores dos doentes em hemodiálise: resultados clínicos

Introduction

The peripheral vascular atherosclerotic disease is a characteristic complication in patients with end‐stage renal disease (ESRD) and shows a particular predilection for diffuse, calcifying and infra‐popliteal involvement. Despite the advances in endovascular revascularization, the clinical efficacy in these patients is limited and poor results are expected.

Purpose

Determine the clinical outcomes after endovascular revascularization for chronic limb ischemia in patients with ESRD on dialysis and compare the results with patients not on dialysis.

Material and methods

We retrospectively evaluate the results of patients who underwent endovascular revascularization for chronic limb ischemia, between January 2010 and December 2013. The patients were divided into two groups: those with normal renal function and those with end stage renal disease on dialysis. The primary end points were: limb salvage and mortality and the secondary endopoints: technical success, wound healing rate, time for wound healing and complications.

Results

Of the total of 217 patients, 32 patients were excluded due to absence of data and 9 patients with renal insuficiency but not end‐stage. 176 patients underwent endovascular revascularization (a total of 182 limbs, median age of 65 years old, 78% males). 45 patients were on dyalisis program. Median follow‐up was 26,6 months.

In patients with Rutherford categories 4, 5 and 6, the limb salvage rate, at 12 months, was 90,4% in patients not on dialysis, and 69,6% in patients on dialysis. The survival rate at 12 monts was lower in patients on dialysis (86% vs 97,1%)

The wound healing rate was also lower in patients on dialysis (60% vs 80%) and with longer median healing times (96 vs 61 days)

Discussion

The presence of end stage renal disease is associated with a higher rate of limb loss and mortality. Despite the discouraging results, for these patients, it should be offered the less invasive endovascular revascularization treatment and an earlier referral.