Significance of Phlebosclerosis in Non-healing Ischaemic Foot Ulcers of End-stage Renal Disease

Abstract

Objectives To determine the influence of haemodialysis on the poor healing of ischaemic ulcers in end-stage renal failure patients regardless of successful revascularization. Materials and methods We investigated the microscopic findings of subcutaneous small vessels in the amputated limbs of 78 patients (27 diabetic/haemodialysis, 26 diabetic/non-haemodialysis and 25 non-diabetic/non-haemodialysis patients) who underwent foot/toe or limb amputation because of ischaemic foot ulcers in the period between 1998 and 2006. All the haemodialysis patients were diabetic. Multivariate logistic analysis was conducted to identify important clinical factors related to the histological findings. Results Marked medial thickening was observed in both small veins and arteries in diabetic patients compared with non-diabetic patients. In diabetics, there was significant medial thickening of small veins, which was greater in haemodialysis patients than in non-haemodialysis patients (Dunnett test, P < 0.05). Multivariate analysis indicated that haemodialysis treatment (odds ratio 14.12, P < 0.01), ABI value (odds ratio 5.41, P < 0.01) and poor stump wound healing (odds ratio 6.19, P = 0.03) were important factors related to medial thickening of small veins. Conclusions Our data suggest that medial thickening of small veins, or phlebosclerosis, might affect the healing of ischaemic ulcers in end-stage renal failure, although the strong influence of diabetes cannot be ignored.