Efficacy of endovascular tibial interventions in end stage renal disease (ESRD) patients with critical limb ischemia (CLI).
Ahmed Mohamed, MD, Ross McFall, MD, Francis Loh, BA, Eric Peden, MD.
Houston Methodist Hospital, Houston, TX, USA.
OBJECTIVES: Retrospective review of outcomes of endovascular tibial interventions in ESRD versus non ESRD patients
METHODS: Patients who underwent endovascular tibial interventions from January 2014 through September 2016 were retrospectively reviewed. Data regarding demographics, prior vascular including tibial interventions and subsequent necessary interventions, and their outcomes were collected. Kaplan-Meier analysis was performed to assess the rates of patency, limb loss, and survival.
RESULTS: Between January 2014 and September 2016, tibial interventions were carried out on 153 limbs of 124 patients. Patients had an average age of 66 years. 87 (70%) were male, and 60 (48%) had ESRD. 78 (51%) limbs were treated from non-ESRD patients while 75 (49%) were from ESRD patients. 42 (66%) of the non-ESRD patients and 46 (77%) of the ESRD patients were found to have diabetes (P = 0.25). The Rutherford’s class distribution was found to be Class III in 4 limbs, Class IV in 25, Class V in 91, and Class VI in 32; critical limb ischemia composed 97% of the diagnoses. Balloon angioplasty was performed in 144 (94%) limbs, atherectomy in 12 (8%), and stents in 5 (3%). At 12 months, primary patency was 65% versus 69% (P = 0.73) while secondary patency was 76% versus 82% (P = 0.47) in ESRD and non-ESRD patients, respectively. Log-rank P values for ESRD versus non-ESRD were 0.96 and 0.94 for primary and secondary patencies, respectively. Mortality rate at 12 months was higher in the ESRD group at 10 (17%) patients compared to 1 (2%) patient in the non-ESRD group (P = 0.003). There was no difference in the reintervention rate between ESRD (41%) and non-ESRD (41%) groups (P = 1.0). The rate of limb loss at 12 months was 18% in limbs of non-ESRD patients and 24% in limbs of ESRD patients (P = 0.47).
CONCLUSIONS: Compared to outcomes reported in the literature, we report higher patencies at 6 and 12 months with similar limb salvage rates. We recommend offering the same treatment choices to ESRD patients as non-ESRD patients, citing similar re-intervention rates and statistically non-significant differences in limb loss.
| 12 months outcomes per limbs | ESRD (75) | Non-ESRD (78) | Total limbs (153) |
| Primary Patency | 65% | 69% | 67% |
| Secondary Patency | 76% | 82% | 79% |
| Amputation rate | 24% | 18% | 21% |
| Mortality (per 124 patients) | 17% (10/60) | 2% (1/64) | 9%(11/124) |
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