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[Prevention and therapy of critical ischemia in hemodialyzed patients]
M Andreoli1, G Galli, A Arienzo
1Strutture Complesse di Chirurgia Vascolare, Azienda Ospedaliera C. Poma, Mantova 46100, Italy.
Insights
Patients with chronic renal failure face significantly higher cardiovascular disease mortality. Early diagnosis and advanced treatments like endovascular surgery improve outcomes, though amputation remains crucial for severe cases.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- Cardiovascular disease (CVD) is a major cause of mortality in patients with chronic renal failure (CRF), with a 10-20 times higher risk compared to the general population.
- CRF patients face additional CVD risk factors including mineral metabolism alterations, hyperhomocysteinemia, and chronic vascular inflammation.
- Vascular disease in CRF patients is often diagnosed late, hindering timely intervention and potentially worsening prognosis.
Purpose of the Study:
- To highlight the increased cardiovascular disease burden in chronic renal failure patients.
- To emphasize the importance of early diagnosis and treatment for vascular disease in CRF.
- To review diagnostic methods and treatment outcomes, including revascularization and amputation, in this high-risk population.
Main Methods:
- Review of diagnostic modalities for vascular disease in CRF patients, including digital angiography, angio-NMR, and angio-CT.
- Analysis of treatment outcomes for revascularization procedures (PTA, bypass) in dialysis patients.
- Evaluation of the role of endovascular surgery and amputation in managing advanced vascular complications.
Main Results:
- Dialysis patients exhibit high overall mortality.
- Revascularization procedures, especially for peripheral occlusive disease, offer limited guarantees of success in CRF patients.
- Endovascular surgery has shown significant improvements in short-term prognosis for these patients.
- Amputation remains a necessary intervention for non-reconstructable, compromised limbs with gangrene or infection.
Conclusions:
- Chronic renal failure significantly elevates cardiovascular and vascular disease risks and mortality.
- Early diagnosis and comprehensive management, incorporating advanced endovascular techniques, are critical for improving outcomes.
- Despite advances, amputation remains an essential treatment option for limb salvage in severe, non-reconstructable cases.
Abstract:
The cardiovascular disease is largely increased in chronic renal failure and the patients have a 10-20 times higher mortality respect normal population. Besides habitual risk-factors they add the mineral metabolism alterations, iperomocisteine and chronical vessel flogosis. In these patients the vascular disease is often lately diagnosed, but early diagnosis would be extremely important to establish appropriate pharmacologic or surgical treatment (PTA or by pass). The basic diagnostic methods are still digital angiography, angio-NMR or angio-CT. In our experience appears that dialysed patients present high total mortality and re-vascolarization (particularly for peripheral occlusive disease) gives less guarantee of success. During last years endovascular surgery procedures extremely improved short-term prognosis for these patients. When there is no space for the re-vascolarization and the situation is strongly compromised by the presence of extended gangrene or infected lesion, amputation is still indicated and can be considered the only possible solution.
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