PMID- 32571134
OWN - NLM
STAT- MEDLINE
DCOM- 20201102
LR  - 20201102
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
VI  - 27
IP  - 4
DP  - 2020 Aug
TI  - Infrapopliteal Anatomic Severity and Delayed Wound Healing in Patients With 
      Chronic Limb-Threatening Ischemia in the Era of the Global Limb Anatomic Staging 
      System.
PG  - 641-646
LID - 10.1177/1526602820933880 [doi]
AB  - Purpose: To investigate the prognostic impact of infrapopliteal (IP) artery 
      anatomic severity according to the Global Limb Anatomic Staging System (GLASS) on 
      delayed wound healing in patients with chronic limb-threatening ischemia (CLTI). 
      Materials and Methods: This study retrospectively analyzed 639 limbs with tissue 
      loss in 484 CLTI patients (mean age 74+/-10 years; 300 men) presenting IP lesions 
      treated with endovascular therapy between April 2010 and December 2015. 
      Two-thirds of patients had diabetes (323, 67%) and over half were on hemodialysis 
      (255, 53%). More than a third of the limbs (251, 39%) were classified as clinical 
      stage 4 according to the Wound, Ischemia, and foot Infection (WIfI) system. IP 
      anatomic severity was classified based on preprocedural angiography according to 
      the GLASS. Severity of arterial calcification was assessed using high-intensity 
      fluoroscopy and classified into 3 groups: none (grade 0), unilateral (grade 1), 
      and bilateral (grade 2). Poor below-the-ankle (BTA) runoff was defined as the 
      lack of a pedal arch with 0 to 1-vessel runoff within the dorsal pedis artery and 
      the lateral and medial plantar arteries. The outcome measure was 1-year wound 
      healing. The association of anatomic characteristics with delayed wound healing 
      was evaluated using Cox proportional hazards regression analysis. Outcomes are 
      presented as the adjusted hazard ratio (HR) with 95% confidence interval (CI). 
      Results: During a mean follow-up of 22+/-19 months, the 1-year cumulative wound 
      healing rate was estimated to be 59.0% (95% CI 54.5% to 63.5%). Multivariable 
      analysis demonstrated independent associations between delayed wound healing and 
      IP calcification grade (HR 1.24, 95% CI 1.02 to 1.50, p=0.027) and poor BTA 
      runoff (HR 1.39, 95% CI 1.04 to 1.85, p=0.025) but not the GLASS IP grade (HR 
      0.92, 95% CI 0.82 to 1.14, p=0.21). Conclusion: The current study revealed that 
      IP arterial calcification and poor BTA runoff were significantly associated with 
      delayed wound healing, whereas the GLASS was not predictive of wound healing.
FAU - Hata, Yosuke
AU  - Hata Y
AUID- ORCID: 0000-0001-5482-3502
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
FAU - Iida, Osamu
AU  - Iida O
AUID- ORCID: 0000-0001-6829-7304
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
FAU - Takahara, Mitsuyoshi
AU  - Takahara M
AD  - Department of Diabetes Care Medicine, Osaka University Graduate School of 
      Medicine, Suita, Osaka, Japan.
FAU - Asai, Mitsutoshi
AU  - Asai M
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
FAU - Masuda, Masaharu
AU  - Masuda M
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
FAU - Okamoto, Shin
AU  - Okamoto S
AUID- ORCID: 0000-0002-9178-5514
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
FAU - Ishihara, Takayuki
AU  - Ishihara T
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
FAU - Nanto, Kiyonori
AU  - Nanto K
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
FAU - Kanda, Takashi
AU  - Kanda T
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
FAU - Tsujimura, Takuya
AU  - Tsujimura T
AUID- ORCID: 0000-0002-3128-1357
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
FAU - Okuno, Shota
AU  - Okuno S
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
FAU - Matsuda, Yasuhiro
AU  - Matsuda Y
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
FAU - Mano, Toshiaki
AU  - Mano T
AD  - Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
LA  - eng
PT  - Journal Article
DEP - 20200617
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Chronic Disease
MH  - *Clinical Decision Rules
MH  - *Endovascular Procedures/adverse effects/instrumentation
MH  - Female
MH  - Humans
MH  - Ischemia/diagnostic imaging/*therapy
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/diagnostic imaging/*therapy
MH  - *Popliteal Artery/diagnostic imaging/physiopathology
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Stents
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Calcification/diagnostic imaging/*therapy
MH  - *Wound Healing
OTO - NOTNLM
OT  - Global Limb Anatomic Staging System
OT  - calcification
OT  - chronic limb-threatening ischemia
OT  - critical limb ischemia
OT  - endovascular therapy
OT  - infrapopliteal arteries
OT  - risk stratification
OT  - runoff
OT  - wound healing
EDAT- 2020/06/24 06:00
MHDA- 2020/11/03 06:00
CRDT- 2020/06/24 06:00
PHST- 2020/06/24 06:00 [pubmed]
PHST- 2020/11/03 06:00 [medline]
PHST- 2020/06/24 06:00 [entrez]
AID - 10.1177/1526602820933880 [doi]
PST - ppublish
SO  - J Endovasc Ther. 2020 Aug;27(4):641-646. doi: 10.1177/1526602820933880. Epub 2020 
      Jun 17.