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Differences in major limb outcomes by indication for lower extremity endovascular revascularization in patients receiving hemodialysis

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Abstract

The incidence of lower extremity artery disease (LEAD) in patient receiving hemodialysis is remarkably higher than the general population. The treatment strategy and prognosis for LEAD patients differs depending on whether a patient has intermittent claudication (IC) or critical limb-threatening ischemia (CLTI). However, the distinction between the prognosis in HD-dependent patients with IC and CLTI has not been fully elucidated. This study is to determine whether indication of PAD has a distinct impact on major adverse cardiovascular and cerebrovascular events (MACCE) and limb events in patients receiving hemodialysis. The current study included 2321 prospectively enrolled patients from the Tokyo taMA peripheral vascular intervention research ComraDE registry (UMIN-CTR no. UMIN000015100) between September 2014 and December 2016. Out of the enrolled patients, 1644 were not receiving hemodialysis (non-HD patients) and 603 were receiving hemodialysis (HD patients). A composite of all-cause death, myocardial infarction, and stroke events defined as MACCE; while limb events were defined as a composite of unscheduled major amputation, unscheduled major lower limb surgery, acute limb ischemia, unscheduled endovascular treatment, and target lesion revascularization. Propensity score matching was applied among the non-HD and HD patients, in whole group, IC subgroup, and CLTI subgroup. Kaplan–Meier analysis was used for the analysis of outcomes for the whole group, IC subgroup, and the CLTI subgroup. CLTI accounted for 75.5% of the HD patients, whereas IC was 63.4% in the non-HD patients. The HD patients exhibited more frequent below-the-knee lesions than those in the non-HD patients in both IC (p = 0.01) and CLTI (p < 0.001) subgroups. Overall, HD patients exhibited a significantly higher rate of MACCE at 24 months. This trend was similar for limb events in whole group and CLTI subgroup. In contrast, no significant differences in outcomes for limb events were found in IC subgroup. Although, prognosis after EVT in HD patients were significantly worse than non-HD patients, comparable outcome with non-HD patients was observed in the patients treated for IC. Clinical trial registration: This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR No. UMIN000015100).

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan

    Takamasa Iwai

  2. Department of Cardiovascular Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, Tokyo, 105-8470, Japan

    Tetsuo Yamaguchi & Yo Fujimoto

  3. Department of Cardiology, Kameda Medical Center, Chiba, Japan

    Daisuke Ueshima

  4. Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kamakura , Kanagawa, Japan

    Kazuki Tobita

  5. Department of Cardiology, St. Luke’s International Hospital, Tokyo, Japan

    Atsushi Mizuno

  6. Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan

    Ryoichi Miyazaki

  7. Department of Cardiology, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan

    Tsukasa Shimura

  8. Department of Cardiology, Shuuwa General Hospital, Saitama, Japan

    Ryo Goto

  9. Department of Cardiology, Tokyo Medical University, Tokyo, Japan

    Naotaka Murata

  10. Department of Cardiology, Ota Memorial Hospital, Gunma, Japan

    Hitoshi Anzai

  11. Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan

    Michiaki Higashitani

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  1. Takamasa Iwai
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  2. Tetsuo Yamaguchi
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  12. Michiaki Higashitani
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Correspondence to Tetsuo Yamaguchi.

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Iwai, T., Yamaguchi, T., Ueshima, D. et al. Differences in major limb outcomes by indication for lower extremity endovascular revascularization in patients receiving hemodialysis. Heart Vessels 38, 488–496 (2023). https://doi.org/10.1007/s00380-022-02195-9

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