Outcomes of femoropopliteal interventions for critical ischemia in the hemodialysis-dependent patient

Background The number of patients maintained on hemodialysis is rising. There are limited data on the outcomes of femoropopliteal interventions, both open and endovascular, in this population. This report examines the anatomic and clinical outcomes in this population. Methods A database of patients undergoing open (OPEN) and endoluminal (ENDO) intervention for femoropopliteal disease (2000 to 2010) was retrospectively queried. Patients on hemodialysis with critical ischemia at the time of surgery or intervention were selected. Patients who underwent tibial bypass or had concomitant tibial interventions were excluded. Kaplan-Meier analyses were performed to assess time-dependent outcomes. Factor analyses were performed for time-dependent variables. Results One hundred sixty-one hemodialysis-dependent patients underwent either OPEN or ENDO procedures for critical ischemia. Of these, 70 patients were treated with OPEN procedures and 91 with ENDO procedures. ENDO patients were more likely to present with a higher cardiac risk index (P = 0.0001), metabolic syndrome (P = 0.02), cerebrovascular disease (P = 0.01), and a dependent living status preoperatively (P = 0.04). ENDO patients presented with more rest pain and tissue loss (P = 0.03). OPEN patients presented with more advanced lesions (P = 0.04). Combined morbidity was higher in the OPEN group (P = 0.05). Cumulative patency (P = 0.04) and clinical efficacy (P = 0.05) were higher in the OPEN group compared to those in the ENDO group. Conclusions Hemodialysis patients undergoing femoral-popliteal endovascular interventions for symptomatic disease have a low cumulative patency and clinical efficacy. Although open surgical revascularization has higher perioperative morbidity and a trend toward higher perioperative mortality, it provides a superior 5-year cumulative patency and clinical efficacy and should be considered in this population subgroup.