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OBJECTIVES: The number of patients maintained on hemodialysis is rising. There is limited data on the outcomes of both open and endovascular femoropopliteal interventions for critical limb ischemia in this population. This report examines the anatomic and clinical outcomes for this problem in this population.
METHODS: A database of patients undergoing open (OPEN) and endoluminal (ENDO) intervention for fem-pop disease (1990 to 2010) was retrospectively queried. Of these interventions, those performed for critical limb ischemia, tissue loss or rest pain, were selected. Patients on hemodialysis at the time of surgery or intervention were selected. Kaplan-Meier analyses were performed to assess time-dependent outcomes. Factor analyses were performed for time-dependent variables.
RESULTS: 2539 patients underwent OPEN or ENDO procedures for symptomatic fem-pop disease over 20 years. One hundred sixty-one (6%) were hemodialysis dependent at the time of surgery or intervention. Of these, 43 patients were treated with OPEN procedures and 77 with ENDO procedures. ENDO patients were more likely to present with a higher cardiac risk index (p<0.05), metabolic syndrome (p<0.05), cerebrovascular disease (p<0.05), and a dependent living status pre-operatively (p<0.05). Combined post-procedural morbidity was higher in the OPEN group (p<0.05). Mortality was higher in the OPEN group (p<0.05). Cumulative patency (p<0.05) and clinical efficacy (p=0.05) were higher in the ENDO group compared to the OPEN group at five years. Overall survival at five years was greater in the OPEN group.
CONCLUSIONS: Hemodialysis patients undergoing femoral-popliteal endovascular interventions for critical limb ischemia have anatomic durability and clinical efficacy at least equal to that of open surgical revascularization combined with a lower perioperative morbidity and mortality. Long term survival in the ENDO group is inferior to the OPEN group which is likely a function of patient selection.