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PERCUTANEOUS ILIAC ANGIOPLASTY AND STENTING IN PATIENTS ON HEMODIALYSIS: ARE THE OUTCOMES THAT POOR?
Mitul S. Patel, M.D., Javier E. Anaya-Ayala, MD, Charu Bavare, M.D., Christopher J. Smolock, M.D., Jean Bismuth, MD, Joseph J. Naoum, MD, Hossam El-Sayed, MD, Eric K. Peden, MD, Alan B. Lumsden, MD, Mark G. Davies, M.D., Ph.D.
The Methodist Hospital, Houston, TX, USA.

Background: Endovascular therapy for symptomatic atherosclerotic iliac artery stenosis is common place, but its outcomes in special populations is poorly described. This study evaluates the outcomes of percutaneous iliac therapy in patients on hemodialysis at a national academic medical center.
Methods: We performed a retrospective analysis of records from patients who underwent endovascular intervention for symptomatic atherosclerotic iliac artery stenosis and were followed by duplex ultrasound between January 1990 and June 2011. Clinical efficacy was defined as the absence of recurrent symptoms, maintenance of ambulation and limb preservation in the index limb.
Results: 324 patients underwent iliac artery interventions: 35 were on HD while the remainder were not (non HD). The 59 percutaneous interventions were performed in the HD patients (60% male, average age 63 yrs, range 43-86). 97% had hypertension, 74% had hyperlipidemia, 40 had metabolic syndrome and 71% were considered diabetic. 29% of these presented with Rest Pain /Tissue loss. 17% of lesions and 6 procedures were to improve inflow for an infra-inguinal procedure, compared to 13% in non-HD patients. There was a 1% technical failure rate. Comparisons of demographics, presenting symptoms and outcomes between the non HD and HD patients are shown in Table 1.
Table 1Non HDHDp-value
Gender (% male)6168NS
Age (mean±SD years)65±1262±11NS
30-day Mortality (%)<1<1NS
Morbidity (%)410.04
Major Adverse Limb Event (MALE %)7260.002
Amputation-Free Survival (%)*73±634±70.002
Clinical Efficacy (%)*87±274±50.05

* at five years
By Cox proportional hazards amputation-free survival and clinical efficacy are worse in HD patients that are diabetic, continue to smoke, or present with tissue loss.
Conclusion: Percutaneous intervention of the iliac artery on dialysis patients is associated with a high morbidity and MALE rate compared to non-HD patients. While intervention success rates are equivalent, clinical efficacy and amputation-free survival are significantly worse in HD patients.


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