Shipra Arya, Stephanie Kingman, Danielle N. Campbell, Dawn M. Coleman, Peter K. Henke, Narasimhan Dasika, Jonathan L. Eliason, John E. Rectenwald, Katherine A. GallagherUniversity of Michigan, Ann Arbor, MI.OBJECTIVES:
As the life-expectancy for renal transplant (RT) patients has improved, interventions for PAD have increased in this cohort. This study compares patency rates, limb salvage and renal morbidity of open or endovascular treatment of PAD in RT patients.
METHODS: A prospective RT registry was queried for patients with PAD procedures from 2002-2011. Demographics, perioperative and patency data were analyzed.
RESULTS: Fifty-five RT recipients (67 extremities) underwent 22 open and 45 endovascular infrainguinal procedures for PAD (Mean age 57.9 years; 76% males). Demographics, comorbid conditions and procedure indications were similar among groups. TASC A/B lesions comprised 83% and 20% of the endovascular and open group, respectively. The rise in creatinine (Cr) level was higher after open interventions (p=0.01). Iodinated contrast (IC) and CO2 were used in 56% of endovascular interventions, while 16% were done with CO2 alone. When CO2 alone was used, there was a decrease in Cr levels compared with IC (p=0.025). There was no increased risk of acute renal failure or long-term RT failure in the endovascular group. KM analysis showed primary patency in patients with critical limb ischemia (CLI) was significantly better for the open group (p=0.05), but secondary patency and limb salvage were similar (Figure 1).
CONCLUSIONS: PAD endovascular interventions are a safe alternative to open surgery for RT patients, and the use of CO2 decreases renal dysfunction in this cohort. Secondary patency and limb salvage are equivalent for open and endovascular revascularization for CLI.
AUTHOR DISCLOSURES: S. Arya: Nothing to disclose; D. N. Campbell: Nothing to disclose; D. M. Coleman: Nothing to disclose; N. Dasika: Nothing to disclose; J. L. Eliason: Nothing to disclose; K. A. Gallagher: Nothing to disclose; P. K. Henke: Nothing to disclose; S. Kingman: Nothing to disclose; J. E. Rectenwald: Nothing to disclose.
Posted April 2013