Long-term outcome of percutaneous transluminal angioplasty in chronic haemodialysis patients with peripheral arterial disease

Yoshitaka Kumada, Toru Aoyama, Hideki Ishii, Miho Tanaka, Yoshihiro Kawamura, Hiroshi Takahashi, Takanobu Toriyama, Toru Aoyama, Yukio Yuzawa, Syoichi Maruyama, Seiichi Matsuo, Toyoaki Murohara

Research output: Contribution to journalArticle

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Abstract

Background. Chronic haemodialysis patients are at an increased risk of peripheral artery disease (PAD). Although percutaneous transluminal angioplasty (PTA) has become a widely used therapeutic intervention for PAD, its outcome in haemodialysis patients remains poorly understood. The aim of this study was to clarify the long-term outcome of PTA as a primary treatment for PAD in haemodialysis patients. Methods. Consecutive 118 haemodialysis patients with 205 lesions and 108 non-haemodialysis patients with 143 lesions who underwent successful PTA as a first-choice therapeutic option for PAD were enrolled. Outcome measures included primary patency, limb salvage and survival. Results. Incidence of diabetes, history of coronary artery disease and femoropopliteal lesion were significantly more frequent in haemodialysis patients (P = 0.008, 0.005 and 0.0001, respectively), but critical limb ischaemia and TransAtlantic Inter-Society Consensus (TASC) lesion types occurred with comparable frequency in both groups. No patients had in-hospital complications. The 5-year primary patency, limb salvage and survival rates were significantly lower in haemodialysis patients (P = 0.01, 0.029 and 0.0024, respectively). On Cox multivariate analysis, haemodialysis was strongly predictive of amputation and all-cause death, but not of restenosis. In haemodialysis patients, TASC C+D lesion and ulceration/gangrene were independent predictors for restenosis and amputation. Conclusions. The long-term outcome after PTA may be fully acceptable in haemodialysis patients who are at the highest risk of cardiovascular disease. PTA is a useful therapeutic strategy in haemodialysis patients with PAD, but PTA for TASC C+D lesions remains controversial.

Original languageEnglish
Pages (from-to)3996-4001
Number of pages6
JournalNephrology Dialysis Transplantation
Volume23
Issue number12
DOIs
Publication statusPublished - 01-12-2008
Externally publishedYes

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Peripheral Arterial Disease
Angioplasty
Renal Dialysis
Limb Salvage
Amputation
Gangrene
Therapeutics
Coronary Artery Disease
Cause of Death
Cardiovascular Diseases
Multivariate Analysis
Ischemia
Survival Rate
Extremities
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Kumada, Yoshitaka ; Aoyama, Toru ; Ishii, Hideki ; Tanaka, Miho ; Kawamura, Yoshihiro ; Takahashi, Hiroshi ; Toriyama, Takanobu ; Aoyama, Toru ; Yuzawa, Yukio ; Maruyama, Syoichi ; Matsuo, Seiichi ; Murohara, Toyoaki. / Long-term outcome of percutaneous transluminal angioplasty in chronic haemodialysis patients with peripheral arterial disease. In: Nephrology Dialysis Transplantation. 2008 ; Vol. 23, No. 12. pp. 3996-4001.
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abstract = "Background. Chronic haemodialysis patients are at an increased risk of peripheral artery disease (PAD). Although percutaneous transluminal angioplasty (PTA) has become a widely used therapeutic intervention for PAD, its outcome in haemodialysis patients remains poorly understood. The aim of this study was to clarify the long-term outcome of PTA as a primary treatment for PAD in haemodialysis patients. Methods. Consecutive 118 haemodialysis patients with 205 lesions and 108 non-haemodialysis patients with 143 lesions who underwent successful PTA as a first-choice therapeutic option for PAD were enrolled. Outcome measures included primary patency, limb salvage and survival. Results. Incidence of diabetes, history of coronary artery disease and femoropopliteal lesion were significantly more frequent in haemodialysis patients (P = 0.008, 0.005 and 0.0001, respectively), but critical limb ischaemia and TransAtlantic Inter-Society Consensus (TASC) lesion types occurred with comparable frequency in both groups. No patients had in-hospital complications. The 5-year primary patency, limb salvage and survival rates were significantly lower in haemodialysis patients (P = 0.01, 0.029 and 0.0024, respectively). On Cox multivariate analysis, haemodialysis was strongly predictive of amputation and all-cause death, but not of restenosis. In haemodialysis patients, TASC C+D lesion and ulceration/gangrene were independent predictors for restenosis and amputation. Conclusions. The long-term outcome after PTA may be fully acceptable in haemodialysis patients who are at the highest risk of cardiovascular disease. PTA is a useful therapeutic strategy in haemodialysis patients with PAD, but PTA for TASC C+D lesions remains controversial.",
author = "Yoshitaka Kumada and Toru Aoyama and Hideki Ishii and Miho Tanaka and Yoshihiro Kawamura and Hiroshi Takahashi and Takanobu Toriyama and Toru Aoyama and Yukio Yuzawa and Syoichi Maruyama and Seiichi Matsuo and Toyoaki Murohara",
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Kumada, Y, Aoyama, T, Ishii, H, Tanaka, M, Kawamura, Y, Takahashi, H, Toriyama, T, Aoyama, T, Yuzawa, Y, Maruyama, S, Matsuo, S & Murohara, T 2008, 'Long-term outcome of percutaneous transluminal angioplasty in chronic haemodialysis patients with peripheral arterial disease', Nephrology Dialysis Transplantation, vol. 23, no. 12, pp. 3996-4001. https://doi.org/10.1093/ndt/gfn378

Long-term outcome of percutaneous transluminal angioplasty in chronic haemodialysis patients with peripheral arterial disease. / Kumada, Yoshitaka; Aoyama, Toru; Ishii, Hideki; Tanaka, Miho; Kawamura, Yoshihiro; Takahashi, Hiroshi; Toriyama, Takanobu; Aoyama, Toru; Yuzawa, Yukio; Maruyama, Syoichi; Matsuo, Seiichi; Murohara, Toyoaki.

In: Nephrology Dialysis Transplantation, Vol. 23, No. 12, 01.12.2008, p. 3996-4001.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term outcome of percutaneous transluminal angioplasty in chronic haemodialysis patients with peripheral arterial disease

AU - Kumada, Yoshitaka

AU - Aoyama, Toru

AU - Ishii, Hideki

AU - Tanaka, Miho

AU - Kawamura, Yoshihiro

AU - Takahashi, Hiroshi

AU - Toriyama, Takanobu

AU - Aoyama, Toru

AU - Yuzawa, Yukio

AU - Maruyama, Syoichi

AU - Matsuo, Seiichi

AU - Murohara, Toyoaki

PY - 2008/12/1

Y1 - 2008/12/1

N2 - Background. Chronic haemodialysis patients are at an increased risk of peripheral artery disease (PAD). Although percutaneous transluminal angioplasty (PTA) has become a widely used therapeutic intervention for PAD, its outcome in haemodialysis patients remains poorly understood. The aim of this study was to clarify the long-term outcome of PTA as a primary treatment for PAD in haemodialysis patients. Methods. Consecutive 118 haemodialysis patients with 205 lesions and 108 non-haemodialysis patients with 143 lesions who underwent successful PTA as a first-choice therapeutic option for PAD were enrolled. Outcome measures included primary patency, limb salvage and survival. Results. Incidence of diabetes, history of coronary artery disease and femoropopliteal lesion were significantly more frequent in haemodialysis patients (P = 0.008, 0.005 and 0.0001, respectively), but critical limb ischaemia and TransAtlantic Inter-Society Consensus (TASC) lesion types occurred with comparable frequency in both groups. No patients had in-hospital complications. The 5-year primary patency, limb salvage and survival rates were significantly lower in haemodialysis patients (P = 0.01, 0.029 and 0.0024, respectively). On Cox multivariate analysis, haemodialysis was strongly predictive of amputation and all-cause death, but not of restenosis. In haemodialysis patients, TASC C+D lesion and ulceration/gangrene were independent predictors for restenosis and amputation. Conclusions. The long-term outcome after PTA may be fully acceptable in haemodialysis patients who are at the highest risk of cardiovascular disease. PTA is a useful therapeutic strategy in haemodialysis patients with PAD, but PTA for TASC C+D lesions remains controversial.

AB - Background. Chronic haemodialysis patients are at an increased risk of peripheral artery disease (PAD). Although percutaneous transluminal angioplasty (PTA) has become a widely used therapeutic intervention for PAD, its outcome in haemodialysis patients remains poorly understood. The aim of this study was to clarify the long-term outcome of PTA as a primary treatment for PAD in haemodialysis patients. Methods. Consecutive 118 haemodialysis patients with 205 lesions and 108 non-haemodialysis patients with 143 lesions who underwent successful PTA as a first-choice therapeutic option for PAD were enrolled. Outcome measures included primary patency, limb salvage and survival. Results. Incidence of diabetes, history of coronary artery disease and femoropopliteal lesion were significantly more frequent in haemodialysis patients (P = 0.008, 0.005 and 0.0001, respectively), but critical limb ischaemia and TransAtlantic Inter-Society Consensus (TASC) lesion types occurred with comparable frequency in both groups. No patients had in-hospital complications. The 5-year primary patency, limb salvage and survival rates were significantly lower in haemodialysis patients (P = 0.01, 0.029 and 0.0024, respectively). On Cox multivariate analysis, haemodialysis was strongly predictive of amputation and all-cause death, but not of restenosis. In haemodialysis patients, TASC C+D lesion and ulceration/gangrene were independent predictors for restenosis and amputation. Conclusions. The long-term outcome after PTA may be fully acceptable in haemodialysis patients who are at the highest risk of cardiovascular disease. PTA is a useful therapeutic strategy in haemodialysis patients with PAD, but PTA for TASC C+D lesions remains controversial.

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