Impact of Hemodialysis on Early and Long-Term Outcomes After Femoral Endarterectomy for Occlusive Disease

Objectives: To investigate the early- and long-term outcomes of femoral endarterectomy (FEA) in patients undergoing hemodialysis (HD) compared with patients who were not. Methods: This single-center retrospective study evaluated 199 limbs of 163 patients (HD group, n = 50; non-HD group, n = 149) who underwent elective FEA between 2013 and 2023. Clinical outcomes were compared between the groups. The primary outcomes included early postoperative morbidity and mortality, primary patency (PP), freedom from major amputation (FFMA), overall survival (OS), and amputation-free survival (AFS). Results: Early morbidity rates were similar between the groups. However, the mortality rate was significantly higher in the HD group than in the non-HD group. There was no significant difference in the 5-year PP rate between the two groups. Furthermore, FFMA, OS, and AFS were significantly lower in the HD group than in the non-HD group. Conclusions: FEA provides acceptable patency outcomes in patients undergoing HD. However, these patients have a higher early postoperative mortality rate and experience significantly poorer limb salvage and OS than non-HD patients. These findings highlight the necessity of careful perioperative management and vigilant long-term follow-up in this high-risk patient population.