Abstract
Amputation of the lower extremities such as the lower limbs or thighs due to critical limb ischemia (CLI), which has become more common in maintenance hemodialysis patients with diabetic nephropathy as a primary disease due to an increase in diabetes in recent years, is known to not only reduce the activity of patients to a very large degree, but also have a serious negative impact on vital prognosis. Therefore, avoiding lower limb amputation or reducing the amputation area when performing treatment for CLI and preserving as much ambulatory function as possible are thought to be critical issues. In this study, we encountered a case in which we were able to avoid major amputation when combined modality therapy including angioplasty, LDL apheresis, and negative pressure wound therapy (NPWT) was performed to treat critical limb ischemia in a maintenance hemodialysis patient. The patient was a 56-year old male who became a hemodialysis patient in January 2010 due to chronic renal failure from diabetic nephropathy. Rest pain appeared in his right lower limb in January 2012 and he was transferred to another hospital for revascularization by bypass surgery. The end of treatment in that hospital led to right transfemoral amputation. The patient was transferred to our hospital in May 2012, and underwent rehabilitation. However, necrosis appeared in the fourth and fifth toes of the left lower limb in early July, and intercurrent infection was observed. The administration of antibiotics was started for the wound infection, and angioplasty and LDL apheresis treatments were given. The patient started local negative pressure wound therapy in late August, which allowed him to avoid major amputation. This suggests that administering negative pressure wound therapy concurrently with existing treatments is an effective therapeutic option for CLI in hemodialysis patients.
