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Tibial intervention for tissue loss yields mixed results in hemodialysis patients
Although safe, tibial intervention for tissue loss in patients on hemodialysis was associated with high rates of major adverse limb events and 30-day amputation.
In a study published in the Journal of Endovascular Therapy, researchers culled data on 242 patients with critical limb ischemia from a prospectively maintained database. All patients underwent isolated tibial interventions for tissue loss in a single limb from 2007 to 2012.
Within the study population, 78 patients (mean age, 66 ± 12 years; 56.4% men) were on hemodialysis and 164 patients (mean age, 50 ± 13 years; 50% men) were not.
Researchers analyzed clinical efficacy outcomes — defined as an absence of recurrent symptoms, ambulation maintenance and not requiring major amputation — along with freedom from major adverse limb events and amputation-free survival.
Compared with those not on hemodialysis, patients who were on hemodialysis experienced a higher rate of MACE at 30 days (5.5% vs. 0%; P = .004); however, both groups were within the objective performance goal of 10% or less, researchers wrote.
Conversely, rates of 30-day major adverse limb events were above the objective performance goal of 9% or less for both groups (no hemodialysis, 13% vs. hemodialysis, 18%; P = .54). Furthermore, among hemodialysis patients, the 1-year rates for amputation-free survival, freedom from major adverse limb events, limb salvage and survival did not attain the Society for Vascular Surgery’s objective performance goals.
At 3 years, patients who were not on hemodialysis had higher rates of clinical efficacy (61% vs. 25%), amputation-free survival (54% vs. 22%) and freedom from major adverse limb events (56% vs. 27%; P < .01 for all).
“This study has demonstrated that tibial interventions for tissue loss can be performed safely, with excellent immediate technical results and a low occurrence of MACE in the [hemodialysis] patients,” the researchers wrote. “The presence of [hemodialysis] has a significant impact on the clinical outcomes. The 30-day [major adverse limb events] rate and the number of major amputations are higher than expected by virtue of the nature of the presenting symptoms. [Amputation-free survival] and freedom from [major adverse limb events] are low, and clinical efficacy drops to low levels within 3 years.” – by Brian Ellis
Disclosure: The researchers report no relevant financial disclosures.