Gilmore Denis, Dib Martin, Evenson Amy, Schermerhorn Marc, Wyers Mark, Chaikof Elliot, Hamdan Allen
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Ann Vasc Surg. 2014 Jan;28(1):159-63. doi: 10.1016/j.avsg.2012.12.007. Epub 2013 Sep 5.
End-stage renal disease is a significant negative predictor of limb salvage and patient survival in patients with limb ischemia, but little is known of the overall effects of renal transplantation. Endovascular management may be less morbid than open surgery, but technical success and durability in these patients is not well established.
All patients with functioning renal transplants and critical limb ischemia (CLI) treated with endovascular techniques between 2003 and 2010 were retrospectively reviewed for limb salvage, reintervention, pre- and postprocedure creatinine, and estimated glomerular filtration rate (eGFR), and overall survival. Contralateral common femoral access, low-profile techniques, and isosmolar contrast were standard for all interventions.
Endovascular interventions were performed on 57 limbs in 28 patients with renal transplants. Mean age was 54 years, 78% were male, 85% were diabetic, 100% were hypertensive, and 64% had a positive smoking history. All patients were treated for CLI. Treated regions included 16 iliac, 19 superficial femoral, 16 popliteal, and 12 tibial arteries, as well as 1 bypass graft with initial technical success of 100% and 0% 30-day mortality. Of all lesions, 43% required reintervention during the follow-up period, the majority in the first year. There was no significant change in eGFR or creatinine comparing pre- and post-angiogram value. Limb salvage and 1-year survival were 83% and 82%, respectively.
Endovascular management of CLI in renal transplant patients results in good technical success and can be accomplished without a measurable change in transplant kidney function, although it requires repeat interventions. Endovascular therapy is a reasonable first-line treatment option for this high-risk group.
终末期肾病是肢体缺血患者肢体挽救和患者生存的重要负面预测指标，但肾移植的总体影响尚不清楚。血管内治疗可能比开放手术的并发症少，但这些患者的技术成功率和耐久性尚未得到充分证实。
回顾性分析2003年至2010年间所有接受血管内技术治疗的具有功能的肾移植且患有严重肢体缺血（CLI）的患者的肢体挽救情况、再次干预情况、血管造影术前和术后的肌酐水平以及估计肾小球滤过率（eGFR）和总体生存率。所有干预均采用对侧股总动脉入路、低轮廓技术和等渗造影剂作为标准。
对28例肾移植患者的57条肢体进行了血管内干预。平均年龄为54岁，78%为男性，85%患有糖尿病，100%患有高血压，64%有吸烟史阳性。所有患者均接受CLI治疗。治疗部位包括16条髂动脉、19条股浅动脉、16条腘动脉和12条胫动脉，以及1条旁路移植血管，初始技术成功率为100%，30天死亡率为0%。在所有病变中，43%在随访期间需要再次干预，大多数在第一年。血管造影术前和术后的eGFR或肌酐水平无显著变化。肢体挽救率和1年生存率分别为83%和82%。
肾移植患者CLI的血管内治疗技术成功率良好，且在不显著改变移植肾功能的情况下即可完成，尽管需要重复干预。血管内治疗是该高危人群合理的一线治疗选择。
