Heart and Vessels

, Volume 31, Issue 9, pp 1476–1483 | Cite as

Nitinol stent implantation for femoropopliteal disease in patients on hemodialysis: results of the 3-year retrospective multicenter APOLLON study

  • Masahiko Fujihara
  • Akihiro Higashimori
  • Yoshihiro Kato
  • Hiromasa Taniguchi
  • Yusuke Iwasaki
  • Tomonori Amano
  • Akinori Sumiyoshi
  • Daisuke Nishiya
  • Yoshiaki Yokoi
Original Article


The clinical outcomes of nitinol stents for femoropopliteal arterial (FP) disease in patients on hemodialysis were assessed. Endovascular therapy (EVT) is accepted for symptomatic FP disease. However, the clinical outcomes of patients on dialysis are not well known. A multicenter retrospective study was conducted with data between November 2010 and August 2013. A total of 484 consecutive patients who successfully underwent EVT for FP disease with nitinol stents were recruited and analyzed. Patients were categorized into the hemodialysis group (N = 161) and non-hemodialysis group (N = 323). The primary measure was primary patency verified by duplex ultrasound at a rest peak systolic velocity (PSVR) of >2.5, and secondary measures were freedom from target lesion revascularization (TLR) and major amputation-free survival (AFS). Average follow-up duration was 19.5 ± 13.5 months. The primary patency rate at 3 years was significantly lower in the hemodialysis group than the non-hemodialysis group (33.8 vs. 43.7 %; p = 0.036). Freedom from TLR at 3 years was 55.0 % in the hemodialysis group and 66.1 % in the non-hemodialysis group (p = 0.032). The hemodialysis group showed a significantly lower AFS rate at 3 years than the non-hemodialysis group (86.4 vs. 58.2 %; p < 0.001). In hemodialysis patients, nitinol stent use resulted in a lower patency rate, higher TLR rate, and lower AFS rate compared to non-hemodialysis patients. These data suggest that nitinol stent implantation for FP arteries in hemodialysis patient needs to be reconsidered.


Hemodialysis Femoropopliteal artery disease Endovascular therapy Nitinol stent 


Compliance with ethical standards

Conflict of interest

The authors have no commercial, proprietary, or financial interest in any products or companies described in this article.


  1. 1.
    Bethesda MD, United States Renal Data System. Annual Data Report, National Institute of Health (2000) National Institute of Diabetes and Digestive and Kidney Disease, Division of Kidney, Urologic and Hematologic Disease:339–348Google Scholar
  2. 2.
    Eggers PW, Gohdes D, Pugh J (1999) Nontraumatic lower extremity amputations in the Medicare end-stage renal disease. Kidney Int 56(4):1524–1533CrossRefPubMedGoogle Scholar
  3. 3.
    O’Hare A, Johansen K (2001) Lower-extremity peripheral arterial disease among patients with end-stage renal disease. J Am Soc Nephrol 12(12):2838–2847PubMedGoogle Scholar
  4. 4.
    Lamar Welch VL, Casper M, Greenlund K, Zheng ZJ, Giles W, Rith-Najarian S (2002) Prevalence of lower extremityarterial disease defined by the ankle-branchial index among American Indians: the inter-tribal heart project. Ethnicity Dis 12(1):S1–S63Google Scholar
  5. 5.
    Schillinger M, Sabeti S, Loewe C, Dick P, Amighi J, Mlekusch W, Schlager O, Cejna M, Lammer J, Minar E (2006) Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med 354:1879–1888CrossRefPubMedGoogle Scholar
  6. 6.
    Yano H, Horinaka S, Yagi H, Ishimitsu T (2013) Comparison of inflammatory response after implantation of sirolimus- and paclitaxel-eluting stents in patients on hemodialysis. Heart Vessels 28(3):308–315CrossRefPubMedGoogle Scholar
  7. 7.
    Graziani L, Silvestro A, Bertone V, Manara E, Alicandri A, Parrinello G, Manganoni A (2007) Percutaneous transluminal angioplasty is feasible and effective in patients on chronic dialysis with severe peripheral artery disease. Nephrol Dial Transplant 22:1144–1149CrossRefPubMedGoogle Scholar
  8. 8.
    Rutherford RB, Becker GJ (1991) Standards for evaluating and reporting the results of surgical and percutaneous therapy for peripheral arterial disease. J Vasc Interv Radiol 2:169–174CrossRefPubMedGoogle Scholar
  9. 9.
    Bosiers M, Torsello G, Gissler HM, Ruef J, Müller-Hülsbeck S, Jahnke T, Peeters P, Daenens K, Lammer J, Schroë H, Mathias K, Koppensteiner R, Vermassen F, Scheinert D (2009) Nitinol stent implantation in long superficial femoral artery lesions: 12-month results of the durability I study. J Endovasc Ther 16:261–269CrossRefGoogle Scholar
  10. 10.
    Rocha-Singh KJ, Zeller T (2014) Jaff MR (2014) Peripheral arterial calcification: prevalence, mechanism, detection, and clinical implications. Catheter Cardiovasc Interv 83(6):E212–E220CrossRefPubMedGoogle Scholar
  11. 11.
    Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White C, White J, Clement D, Creager M, Jaff M, Mohler E 3rd, Rutherford RB, Sheehan P, Sillesen H, Rosenfield K, TASC II Working Group (2007) Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg 33(suppl 1):S1–S75Google Scholar
  12. 12.
    Laird JR, Katzen BT, Scheinert D, Lammer J, Carpenter J, Buchbinder M, Dave R, Ansel G, Lansky A, Cristea E, Collins TJ, Goldstein J, Jaff MR, RESILIENT Investigators (2010) Nitinol stent implantation versus balloon angioplasty for lesions in the superficial femoral artery and proximal popliteal artery: twelve month results from the resilient randomized trial. Circ Cardiovasc Interv 3:267–276CrossRefPubMedGoogle Scholar
  13. 13.
    Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, Zeller T, Roubin GS, Burket MW, Khatib Y, Snyder SA, Ragheb AO, White JK, Machan LS, Investigators Zilver PTX (2011) Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv 4:495–504CrossRefPubMedGoogle Scholar
  14. 14.
    Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, Snyder SA, O’Leary EE, Tepe G, Scheinert D, Zeller T, Zilver PTX Investigators (2013) Sustained safety and effectiveness of paclitaxel-eluting stents for femoropopliteal lesions: 2-year follow-up from the Zilver PTX randomized and single-arm clinical studies. J Am Coll Cardiol 61:2417–2427CrossRefPubMedGoogle Scholar
  15. 15.
    O’Hare AM, Sidawy AN, Feinglass J, Merine KM, Daley J, Khuri S, Henderson WG, Johansen KL (2004) Influence of renal insufficiency on limb loss and mortality after initial lower extremity surgical revascularization. J Vasc Surg 39:709–716CrossRefPubMedGoogle Scholar
  16. 16.
    Fujihara M, Utsunomiya M, Higashimori A, Yokoi Y, Nakamura M (2014) Outcomes of Zilver PTX stent implantation for the treatment of complex femoropopliteal artery disease. Heart Vessels. doi: 10.1007/s00380-014-0596-2 PubMedGoogle Scholar
  17. 17.
    Leskinen Y, Salenius JP, Lehtimäki T, Huhtala H, Saha H (2002) The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: requirements for diagnostics. Am J Kidney Dis 40:472–479CrossRefPubMedGoogle Scholar
  18. 18.
    O’Hare AM (2005) Management of peripheral arterial disease in chronic kidney disease. Cardiol Clin 23:225–236CrossRefPubMedGoogle Scholar
  19. 19.
    Zdanowski Z, Albrechtsson U, Lundin A, Jonung T, Ribbe E, Thörne J, Norgren L (1999) Percutaneous transluminal angioplasty with or without stenting for femoropopliteal occlusions? A randomized controlled study. Int Angiol 18:251–255PubMedGoogle Scholar
  20. 20.
    Kawamura Y, Ishii H, Aoyama T, Tanaka M, Takahashi H, Kumada Y, Toriyama T, Murohara T (2009) Nitinol stenting improves primary patency of the superficial femoral artery after percutaneous transluminal angioplasty in hemodialysis patients: a propensity-matched analysis. J Vasc Surg 50:1057–1062CrossRefPubMedGoogle Scholar
  21. 21.
    Rocha-Singh KJ, Jaff MR, Crabtree TR, Bloch DA, Ansel G, Physicians Inc VIVA (2007) Performance goals and endpoint assessments for clinical trials of femoropopliteal bare nitinol stents in patients with symptomatic peripheral arterial disease. Circ Cardiovasc Interv 69:910–919CrossRefGoogle Scholar
  22. 22.
    Gardner AW, Parker DE, Montgomery PS, Khurana A, Ritti-Dias RM (2010) Blevins SM (2010) Gender differences in daily ambulatory activity patterns in patients with intermittent claudication. J Vasc Surg 52:1204–1210CrossRefPubMedGoogle Scholar
  23. 23.
    Iida O, Yokoi H, Soga Y, Inoue N, Suzuki K, Yokoi Y, Kawasaki D, Zen K, Urasawa K, Shintani Y, Miyamoto A, Hirano K, Miyashita Y, Tsuchiya T, Shinozaki N, Nakamura M, Isshiki T, Hamasaki T, Nanto S, STOP-IC investigators (2013) Cilostazol reduces angiographic restenosis after endovascular therapy for femoropopliteal lesions in the Sufficient Treatment of Peripheral Intervention by Cilostazol study. Circulation 127(23):2307–2315CrossRefPubMedGoogle Scholar
  24. 24.
    Soga Y, Iida O, Hirano K, Suzuki K, Tosaka A, Yokoi H, Nobuyoshi M (2011) Utility of new classification based on clinical and lesional factors after self-expandable nitinol stenting in the superficial femoral artery. J Vasc Surg 54(4):1058–1066CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2015

Authors and Affiliations

  • Masahiko Fujihara
    • 1
  • Akihiro Higashimori
    • 1
  • Yoshihiro Kato
    • 2
  • Hiromasa Taniguchi
    • 2
  • Yusuke Iwasaki
    • 3
  • Tomonori Amano
    • 4
  • Akinori Sumiyoshi
    • 5
  • Daisuke Nishiya
    • 6
  • Yoshiaki Yokoi
    • 1
  1. 1.Department of CardiologyKishiwada Tokushukai HospitalKishiwadaJapan
  2. 2.Department of CardiologySaiseikai Noe HospitalOsakaJapan
  3. 3.Department of CardiologyOsaka General Medical CenterOsakaJapan
  4. 4.Department of CardiologyUji Tokushukai HospitalKyotoJapan
  5. 5.Department of CardiologySakurabashi Watanabe HospitalOsakaJapan
  6. 6.Department of CardiologyHigashi Sumiyoshi Morimoto HospitalOsakaJapan

Personalised recommendations