Clinical outcome of surgical treatment for arteriosclerosis obliterans in chronic hemodialysis patients

Long-term prognosis after surgical treatments for arteriosclerosis obliterans (ASO) in chronic hemodialysis (HD) was retrospectively analyzed in 15 consecutive hemodialysis patients who were admitted to our hospital from July 1, 1995 to June 30, 1999. They consisted of 11 males and 4 females, age ranged from 56 to 98 years with an average of 67±11 (SD) years old and the HD duration ranged from 14 to 234 months with an average of 104±61 months. They were subdivided into 2 groups; DM (n=9, male/female=7/2, the mean age of 65±8 years old, the mean HD duration of 91±55 months) and non-DM patients (n=6, male/female=4/2, the mean age of 69±15 years old, the mean HD duration of 124±71 months). Thirty-four surgical procedures were performed. Amputation of leg, foot or toe was ultimately performed for ASO in all patients with DM. For non-DM patients, revascularization procedures could be performed in 5 patients (80%). The rate of amputation in DM patients was significantly higher than that in non-DM patients (p=0.021). Eleven patients (73%) died within the mean observation period of 20±13 months. In all patients, the first year survival rate was 73%, 42% for the second year and 21% for the third year. The cumulative survival rate in DM patients tended to be worse compared to that in non-DM patients but the difference was not significant. The most frequent cause of death was cardiovascular disease, but ischemic colitis occurred more frequently than cardiac death. Two patients committed suicide probably due to declining activity of daily life after amputations. Two patients became malnourished and finally died of cachexia. Based on this analysis, it is suggested that clinical outcome after surgical treatments for ASO in chronic HD patients, especially in diabetic patients, was poor. Earlier assessments and therapeutic approaches are needed to improve the results.