Abstract
Peripheral arterial disease (PAD) is common in dialysis patients, and significantly associated with morbidity and mortality, while its prevalence appears to be elevated in those who are diabetic or elderly. When a patient develops critical limb ischemia (CLI), an endovascular procedure or open surgical intervention is generally chosen. However, because of existing comorbid conditions, management of CLI in dialysis patients can be difficult. These patients tend to heal slowly, have a high rate of infection, and are frequently at high operative risk, thus decision making related to CLI should be individualized to reflect patient preference and expected prognosis. Although an endovascular procedure can benefit some dialysis patients, many may be poor candidates due to the frequent presence of diffuse and distal lesions. On the other hand, a distal bypass procedure is not universally performed in Japan. It is important to train vascular specialists to treat such difficult patients with the options of endovascular and open surgical intervention strategies available to them.
