Original Articles

Endovascular Treatment of Lower Extremity Ischemia in Chronic Renal Failure Patients on Dialysis: Early and Intermediate Term Results

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Click on the icon on the upper right hand side for the article written by Oleg Pikovsky MD, Maly Oron MD, Arthur Shiyovich MD, Zvi H. Perry MD MA and Lior Nesher MD.
IMAJ 2013: 15: December: 734-738
Abstract
 Background: Peripheral arterial occlusive disease is common in patients with chronic renal failure requiring dialysis. Despite the increasing use of endovascular revascularization for lower extremity ischemia, the success rates of treating lower extremity ischemia in this challenging population remain obscure. 

Objectives: To assess the results of endovascular revascularization for lower extremity ischemia in dialysis patients.


Methods: We conducted a retrospective review of all dialysis patients who underwent endovascular treatment for critical limb ischemia (CLI) in our institution between 2007 and 2011. Data collected included comorbidities, clinical presentation, anatomic distribution of vascular lesions, amputation and survival rates.


Results: We identified 50 limbs (41 patients). Indications included: gangrene in 22%, non-healing wounds in 45%, rest pain in 31%, and debilitating claudication in 4%. Mean follow-up was 12 months (1–51 months). Nineteen patients required amputations. Freedom from amputation at 5 years was 40%. Factors associated with amputation included non-healing wounds or gangrene (68% and 36% respectively) and diabetes (P < 0.05). The survival rate was 80% after 5 years.


Conclusions:  Despite improvement in endovascular techniques for lower extremity revascularization, the incidence of limb salvage among dialysis patients remains poor, resulting in a high rate of major amputations.