A case report of revascularization of culprit lesions in the common femoral/popliteal artery by using thromboendarterectomy in a hemodialysis patient with critical limb ischemia

Abstract

In Japan, the number of patients receiving maintenance hemodialysis has increased to 310,000. Consequently, the incidence of critical limb ischemia (CLI) is also increasing. Major limb amputations due to CLI have a considerable adverse effect on the prognosis for survival. Therefore, the therapeutic goal for CLI is to avoid lower limb amputations and retain walking function as much as possible in order to improve prognosis. We report a case of thromboendarterectomy (TEA), one of surgical revascularization procedures, that was performed successfully to save an affected lower limb of a patient with CLI on maintenance hemodialysis. The subject was a 64-year-old man. In June 2003, he started receiving treatment with peritoneal dialysis for chronic renal failure resulting from polycystic kidney disease. The treatment was switched to hemodialysis in June 2009. In early 2014, intermittent claudication occurred in the right lower limb. The patient’s condition was exacerbated around May with the development of rest pain. Because discrete lesions were found in the right common femoral and popliteal arteries on lower extremity angiography, we performed TEA in June 2014, by which the symptoms improved. Our study results indicate that TEA is a potentially effective treatment option for discrete lesions in hemodialysis patients with CLI.