Department of Internal Medicine, Suzuran Hospital, Suzurandai-Nishimachi, Kita-ku, Kobe-city, Hyogo, Japan.
Ren Fail. 2009;31(9):785-90. doi: 10.3109/08860220903180590.
Peripheral arterial disease (PAD) of the lower limbs carries high risks of leg amputation, quality of life deterioration, and death in hemodialysis (HD) patients. However, the frequency of PAD at the initiation of HD has not been adequately documented. In addition, the applicability of ultrasonography to diagnosing PAD is not yet clear in HD patients.
Twenty-seven patients within three months after HD initiation were enrolled. Ultrasonography was performed regardless of ischemic symptoms. Significant stenosis or obstruction of lower limb arteries on ultrasonography was diagnosed as PAD.
Sixteen of the 27 (59.3%) showed PAD on echography. On the other hand, only six of the 27 (22.2%) had an ABI < 0.9. Sixteen patients had a total of 37 lesions revealed by ultrasonography, and the average number of PAD lesions was 2.3 per patient. The numbers of PAD lesions on ultrasonography were as follows: iliac artery, 7; femoral-popliteal artery, 15; and infra-popliteal artery, 15. The ABI was 0.95 +/- 0.29 in PAD and 1.23 +/- 0.13 in non-PAD patients (p = 0.005).
A high prevalence of PAD at HD initiation was demonstrated. PAD may be missed using only the ABI (ankle brachial index). Ultrasonography is a reliable and non-invasive examination for detecting PAD.
下肢外周动脉疾病（PAD）会使血液透析（HD）患者面临更高的截肢、生活质量下降和死亡风险。然而，HD 起始时 PAD 的发生频率尚未得到充分记录。此外，超声检查在 HD 患者中诊断 PAD 的适用性尚不清楚。
纳入 27 例 HD 起始后 3 个月内的患者。无论是否存在缺血症状，均进行超声检查。超声检查发现下肢动脉有明显狭窄或阻塞，诊断为 PAD。
27 例中有 16 例（59.3%）在超声检查中显示有 PAD。另一方面，27 例中仅有 6 例（22.2%）ABI<0.9。16 例患者共发现 37 处超声显示的病变，平均每位患者有 2.3 处 PAD 病变。超声显示的 PAD 病变数量如下：髂动脉 7 处，股腘动脉 15 处，胫后动脉 15 处。ABI 在 PAD 患者中为 0.95±0.29，在非 PAD 患者中为 1.23±0.13（p=0.005）。
在 HD 起始时发现 PAD 的患病率较高。仅使用 ABI（踝肱指数）可能会漏诊 PAD。超声检查是一种可靠的、非侵入性的检测 PAD 的方法。
