Endovascular Therapy Outcomes Compared by Baseline Tissue Loss in Hemodialysis-Dependent CLI Patients

July 24, 2015—In Catheterization and Cardiovascular Interventions (CCI), Masatsugu Nakano, MD, et al published 3-year clinical outcomes from a study of infrapopliteal angioplasty for critical limb ischemia (CLI) in hemodialysis-dependent (HD) patients with minor or major tissue loss (2015;86:289–298).

As summarized in Catheterization and Cardiovascular Interventions, the study was composed of 449 consecutive HD patients with CLI who underwent endovascular therapy for isolated infrapopliteal lesions from 2004 to 2011. The minor tissue loss group included 340 HD patients with wounds located distal to the metatarsophalangeal joints. The major tissue loss group included 109 HD patients with wounds that extended beyond those joints. The two groups were compared for limb salvage and amputation-free survival rates by Kaplan-Meier analysis.

There was no significant difference in the percentage of diabetic patients between the two groups (minor, 76.5% vs major, 75.2%). The percentage of patients with direct flow to the wound site was lower in the major group than in the minor group (minor, 63.5% vs major, 45.9%).

The investigators reported that at 3 years after endovascular therapy, the minor group had a significantly better limb salvage rate (minor, 83.7% vs major, 71.2%) and amputation-free survival rate (minor, 44.1% vs major, 29.1%).

The study concluded that endovascular therapy is an efficient treatment for HD patients with minor tissue loss, achieving greater than 80% limb salvage rates at 3 years; however, the amputation-free survival rates in all HD patients with tissue loss are < 50% at 3 years, making their prognosis poor.