| Objective:To evaluate the clinical efficiency of endovascular therapy(EVT)in treatment of chronic limb-threatening ischemia(CLTI)patients on dialysis.Methods:The clinical data of patients on dialysis with CLTI admitted to ChinaJapan Friendship Hospital from June 2015 to June 2020 were retrospectively analyzed.The clinical efficiency of EVT in treating CLTI patients on dialysis was analyzed and the factors affecting the survival rate of patients were further analyzed.Results:A total of 28 patients,32 lower extremities underwent EVT of lower extremities artery.Within 30 days after surgery,2 of the 32 patients suffered from major amputation and 2 of the 28 patients died.There were 17(60.7%)male patients,average age 67.7±12.0 years old,20(71.4%)diabetic patients,12(42.9%)patients with cardiovascular disease,13(46.4%)patients with cerebrovascular disease,4(14.3%)patients with chronic heart failure,7(25.0%)patients with smoking history.There were 18(64.3%)patients with hypertension and 22(78.6%)patients with a history of hypertension.The average score of Activity of Daily Living(ADL)was 65.7±22.2 points,the serum alba was 39.3±6.1 g,the average dialysis time was 6.2±5.1 years,and the average follow-up of all patients was 20.8±17.3 months.There were 15(46.9%)Rutherford Grade 4,15(46.9%)Rutherford Grade 5,and 2(6.3%)Rutherford Grade 6.In the Peripheral artery calcification scoring system(PACSS)of all lower limb lesions,there were 20 patients with grade 4,5 patients with grade 3,2 patients with grade 2,and 1 patient with grade 1,of which 11 patients had no obvious calcification.The mean length of the target lesion was 208.4±82.8mm.Within 30 days after surgery,2 of 32 patients had amputation of their affected limbs,and 2 of 28 patients died during the perioperative period,with an average hospital stay of 11.0±8.5 days.At 12 and 24 months,the survival rates were 67.9%and 59.9%,the limb salvage rates were 90.3%and 90.3%,the amputation-free survival rates were 64.3%and 56.3%,the primary patency rates were 77.2%and 58.5%,the secondary patency rates were 89.5%and 72.4%,and the freedom from target lesion revascularization rates were 95.5%and 84.5%.Cox regression analysis showed female patients(HR 5.042,95%CI 1.44117.642,P=0.011)and Rutherford grade Ⅴ and Ⅵ(HR 11.876,95%CI 1.490-94.690,P=0.019)are risk factors affecting survival for patients on dialysis.Conclusion:EVT is an effective treatment for CLTI in dialysis patients,but there is still a high mortality rate in this part of patients during the disease.The sepsis caused by lower extremity ulcer gangrene is one of the main causes of death in patients.Therefore,reasonable debridement and amputation should be adopted in future treatment to avoid the occurrence of poor prognosis. |
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