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Outcomes of isolated Iliac Endovascular Interventions in Hemodialysis Dependent Patients
Tracy Cheun, MD, Georges M. Haidar, MD, Taylor D. Hicks, MD, Mark G. Davies, MD PhD MBA.
UT Health, San Antonio, TX, USA.

Objectives:
Endovascular therapy for symptomatic atherosclerotic iliac artery disease is commonplace, but its outcomes in special populations are poorly described. This study evaluates the outcomes of percutaneous iliac intervention in patients on hemodialysis.
Methods:
We performed a retrospective analysis of records from patients who underwent endovascular intervention for symptomatic atherosclerotic iliac artery disease and were followed by duplex ultrasound between January 2006 and December 2016. Patient orientated outcomes of clinical efficacy (CE; absence of recurrent symptoms, maintenance of ambulation and absence of major amputation), amputation-free survival (AFS; survival without major amputation) and freedom from major adverse limb events (MALE; Above ankle amputation of the index limb or major re-intervention (new bypass graft, jump/interposition graft revision) were evaluated.
Results: 524 patients (60% male, average age 63 yrs, range 43-86) underwent isolated iliac artery interventions: 135 were on HD while the remainder was not on HD (non HD). 97% had hypertension, 74% had hyperlipidemia, 40% had metabolic syndrome and 71% were considered diabetic. 71% presented with claudication and the remainder with rest pain. 51% of the patients had TASCII C and D lesions. There was a 1% technical failure rate. MACE at 30 days was 1.5% with no difference between the groups. No major amputations occurred within 30 days. Comparisons of demographics, presenting symptoms and outcomes between the non-HD and HD patients are shown in Table 1 and show that the HD had a greater morbidity and 30-day MALE rate.

Table 1Non HDHDp-value
Gender (% male)6168NS
Age (mean±SD years)65±1262±11NS
30-day Mortality (%)<1<1NS
Morbidity (%)140.04
Major Adverse Limb Event (MALE %)7160.002
Amputation-Free Survival (%)*73±644±70.002
Clinical Efficacy (%)*87±234±50.05
MALE (%)*73±639±70.002

*Mean±SEM at five years follow up
By Cox proportional hazards in HD patients, amputation-free survival and clinical efficacy are worse that were diabetic, continue to smoke, TASC C/D lesions and have ipsilateral SFA occlusion.
Conclusion:
Isolated percutaneous intervention of the iliac artery on dialysis patients is associated with a high 30-day morbidity and MALE rate compared to non-HD patients. While intervention success rates are equivalent, Patient orientated outcomes of clinical efficacy and amputation-free survival are significantly worse in HD patients.


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