Abstract
The number of patients on chronic hemodialysis has increased in recent years. Therefore, arteriosclerosis should be considered carefully as a serious complication in such patients. Surgical treatment of abdominal aortic aneurysm (AAA) and/or arteriosclerosis obliterans (ASO) may be necessary in some patients. The management of AAA and ASO in patients on chronic hemodialysis is very important, because it affects prognosis and quality of life, particularly in patients with the above complications. In the present study, we examined the clinical features of AAA (n=4) and ASO (n=3) and evaluated the clinical outcome of arterial reconstruction for AAA and ASO in our hospital.
Patients with AAA were aged 45 to 61 years and all had secondary hypertension and had been on hemodialysis for 6 to 60 months. Two patients complained of abdominal or back pain but the other two, in whom AAA was detected coincidentally on palpation of the abdomen, were asymptomatic. All aneurysms were infrarenal in type. Arterial reconstruction was performed by Y graft replacement in three patients and straight graft replacement in one patient. The condition improved in all patients after surgery.
Patients with ASO, aged 51 to 67 years, had been on hemodialysis for 64 to 231 months, and two were hypertensive. All three patients presented with symptoms and findings such as leg pain, intermittent claudication and necrosis of foot. Angiography showed obstruction of the left iliac-popliteal arteries in two patients and obstruction of the right common-external iliac arteries in one patient. Arterial reconstructive surgery was performed by femoro-popliteal bypass using the vena saphena magna in the former two patients and by femoro-femoral crossover bypass which was repeated twice in the latter case. The postoperative course was satisfactory in one patient but the other two died due to other diseases.
Recent advances in surgical techniques and management of hemodialysis before and after operation have facilitated surgical treatment of patients with chronic hemodialysis. However, the outcome in hemodialysis patients with ASO is poor and a thorough investigative workup of the choice of therapy and general state should be performed before surgery.
