Abstract
To assess the clinical benefit of combined treatment of below-knee endovascular therapy (BK-EVT) plus low-density lipoprotein apheresis (LDLA) compared with BK-EVT monotherapy, we retrospectively evaluated the clinical outcome of hemodialysis (HD) patients with critical limb ischemia (CLI) due to isolated BK arterial lesions who underwent BK-EVT or BK-EVT plus short-term LDLA. Between October 2011 and September 2014, 62 HD patients underwent isolated BK-EVT monotherapy (BK-EVT group), and 25 HD patients underwent BK-EVT plus LDLA (BK-EVT + LDLA group). LDLA was started within 1 week after BK-EVT and performed four times in total within next 2 weeks. Major adverse limb events (MALE) including major amputation and re-intervention, and all-cause mortality were examined by Kaplan-Meier method and the log-rank test. Baseline characteristics were not different other than low ABI and low dorsal SPP in BK-EVT + LDLA group. Cumulative MALE-free rate was significantly improved in BK-EVT + LDLA group over the BK-EVT group (72.0% and 45.1% respectively at 30 months after treatment, P = 0.04). All-cause mortality did not differ between the two groups. Major causes of death were heart failure and sepsis in both groups. Short-term LDLA hybrid treatment immediately after BK-EVT might improve the outcome of ischemic limbs after re-vascularization therapy.
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