[Peripheral arteriopathy in ESRD dialysed patients: when and how to intervene]

Area of Science:

• Vascular Surgery
• Nephrology
• Cardiology

Context:

• Critical limb ischemia (CLI) affects 25-30% of patients with chronic peripheral occlusive disease (POAD) undergoing chronic dialysis.
• Infrainguinal arteries are frequently affected by atherosclerotic lesions, often leading to long infrapopliteal occlusions.
• Patients on dialysis often have comorbidities like diabetes, hypertension, and ischemic cardiomyopathy, leading to a poor surgical prognosis.

Purpose:

• To evaluate the outcomes of surgical interventions (open and endovascular) for CLI in chronically dialysed patients.
• To assess the efficacy of these procedures in achieving limb salvage and immediate patency.
• To identify risk factors for medium-term mortality and amputation in this high-risk patient subgroup.

Summary:

• A study of 23 chronically dialysed patients with CLI undergoing surgery (9 open, 13 endovascular) between 2000-2003 showed immediate patency and limb salvage in all cases, despite an 8.6% immediate mortality rate.
• Medium-term follow-up (25 months) revealed five thromboses in subinguinal procedures, leading to major amputations in those patients, while iliac procedures had no thromboses.
• Seven patients died from cardiovascular diseases during follow-up, highlighting the association between POAD, dialysis, and increased medium-term mortality.

Impact:

• Surgical treatment for CLI in dialysis patients can achieve immediate limb salvage, but carries significant risks.
• The combination of POAD and dialysis is a predictor of medium-term death, emphasizing the need for careful patient selection and risk stratification.
• Minimally invasive surgical approaches should be prioritized to mitigate surgical risk and improve outcomes in this vulnerable population.