PMID- 34470712
OWN - NLM
STAT- MEDLINE
DCOM- 20220301
LR  - 20221207
IS  - 1876-4738 (Electronic)
IS  - 0914-5087 (Linking)
VI  - 79
IP  - 1
DP  - 2022 Jan
TI  - Features of asymptomatic contralateral limb in patients with chronic 
      limb-threatening ischemia.
PG  - 153-160
LID - S0914-5087(21)00223-9 [pii]
LID - 10.1016/j.jjcc.2021.08.021 [doi]
AB  - BACKGROUND: The current study aimed to reveal clinical features and prognosis of 
      asymptomatic contralateral limbs in patients undergoing revascularization for 
      chronic limb-threatening ischemia (CLTI). METHODS: We analyzed a database of 520 
      CLTI patients registered in a prospective, multicenter registry in Japan. Severe 
      ischemia in asymptomatic contralateral limbs was determined as the Wound, 
      Ischemia, and foot Infection (WIfI) classification system Ischemia (I) grade 2/3. 
      RESULTS: The prevalence of diabetes mellitus and dialysis-dependent renal failure 
      was 74.2% and 53.5%, respectively. Asymptomatic limbs accounted for 65.0% [95% 
      confidence interval (CI), 60.9-69.1%] of the overall population, and 55.0% (95% 
      CI, 49.6-60.4%) of the asymptomatic contralateral limbs had WIfI I-2/3. The 
      multivariate analysis identified age >/=65 years, dialysis-dependent renal failure, 
      WIfI I-3 in the index limb, and loss of pressure sensation in the contralateral 
      limb as independent risk factors for WIfI I-2/3 in asymptomatic contralateral 
      limbs (all p < 0.05). The 3-year cumulative incidence rate of major adverse limb 
      events (MALE) in asymptomatic contralateral limbs was 19.3% (95% CI, 15.1-23.7%), 
      whereas that of all-cause mortality was 46.9% (95% CI, 41.0-52.5%). The 
      corresponding rate including a composite of mortality and MALE was 58.8% (95% CI, 
      52.9-64.6%). In asymptomatic contralateral limbs, the adjusted hazard ratio of 
      WIfI I-2/3 versus I-0/1 was 1.53 (95% CI, 1.11-2.10) for a composite of mortality 
      and MALE, 1.96 (95% CI, 1.14-3.36) for MALE, and 1.37 (95% CI, 0.95-1.96) for 
      mortality (p = 0.009, 0.015, and 0.091, respectively). CONCLUSIONS: Two-thirds of 
      CLTI patients had an asymptomatic contralateral limb, and approximately half of 
      the asymptomatic contralateral limbs were exposed to severe ischemia. Older age, 
      dialysis-dependent renal failure, WIfI I-3 in the index limb, and loss of 
      pressure sensation in the contralateral limb were independently associated with 
      severe ischemia in asymptomatic contralateral limbs. In addition to mortality, 
      MALE commonly occurred in asymptomatic contralateral limbs, especially with WIfI 
      I-2/3.
CI  - Copyright (c) 2021. Published by Elsevier Ltd.
FAU - Takahara, Mitsuyoshi
AU  - Takahara M
AD  - Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 
      Suita, Japan; Department of Diabetes Care Medicine, Osaka University Graduate 
      School of Medicine, Suita, Japan.
FAU - Iida, Osamu
AU  - Iida O
AD  - Cardiovascular Center, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo 
      660-8511, Japan. Electronic address: iida.osa@gmail.com.
FAU - Soga, Yoshimitsu
AU  - Soga Y
AD  - Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
FAU - Kodama, Akio
AU  - Kodama A
AD  - Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate 
      School of Medicine, Nagoya, Japan.
FAU - Terashi, Hiroto
AU  - Terashi H
AD  - Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, 
      Japan.
FAU - Azuma, Nobuyoshi
AU  - Azuma N
AD  - Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20210829
PL  - Netherlands
TA  - J Cardiol
JT  - Journal of cardiology
JID - 8804703
SB  - IM
MH  - Aged
MH  - Amputation, Surgical
MH  - Chronic Disease
MH  - *Chronic Limb-Threatening Ischemia
MH  - Humans
MH  - Ischemia/epidemiology/etiology
MH  - Limb Salvage/adverse effects
MH  - *Peripheral Arterial Disease
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Asymptomatic contralateral limb
OT  - Chronic limb-threatening ischemia
OT  - Major adverse limb event
OT  - Mortality
OT  - Severe ischemia
COIS- Declaration of Competing Interest The authors declare that there is no conflict 
      of interest.
EDAT- 2021/09/03 06:00
MHDA- 2022/03/03 06:00
CRDT- 2021/09/02 05:47
PHST- 2021/04/23 00:00 [received]
PHST- 2021/08/05 00:00 [revised]
PHST- 2021/08/16 00:00 [accepted]
PHST- 2021/09/03 06:00 [pubmed]
PHST- 2022/03/03 06:00 [medline]
PHST- 2021/09/02 05:47 [entrez]
AID - S0914-5087(21)00223-9 [pii]
AID - 10.1016/j.jjcc.2021.08.021 [doi]
PST - ppublish
SO  - J Cardiol. 2022 Jan;79(1):153-160. doi: 10.1016/j.jjcc.2021.08.021. Epub 2021 Aug 
      29.