PMID- 34802303
OWN - NLM
STAT- MEDLINE
DCOM- 20220711
LR  - 20230524
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
VI  - 29
IP  - 4
DP  - 2022 Aug
TI  - Scoring Model to Predict Major Amputation in Patients With Chronic 
      Limb-Threatening Ischemia at Wound, Ischemia, and Foot Infection Clinical Stage 4 
      After Endovascular Therapy.
PG  - 594-601
LID - 10.1177/15266028211059453 [doi]
AB  - PURPOSE: We investigated the predictors of major amputation (MA) at 1 year and 
      prepared a scoring model to stratify the clinical outcomes of chronic 
      limb-threatening ischemia (CLTI) patients at wound, ischemia, and foot infection 
      (WIfI) clinical stage 4 after endovascular therapy (EVT). MATERIALS AND METHODS: 
      This study was a retrospective, observational study performed at a single center. 
      A total of 353 CLTI patients (390 limbs) were treated with EVT between April 2007 
      and December 2016. Among these, limbs at WIfI clinical stages 1, 2, and 3 were 
      excluded, and 194 limbs at WIfI clinical stage 4 (49.7%) were enrolled. The 
      primary endpoint was major amputation (MA) free rate at 1 year. Predictors of MA 
      at 1 year was evaluated by Cox proportional hazard analysis. RESULTS: At 1 year, 
      the incidence of MA was 18.0% (35 limbs). Cox proportional hazard analysis 
      revealed that hemodialysis (hazard ratio [HR] 2.63; 95% confidence interval [CI], 
      1.24-5.58; p=0.012), fI3 (HR 2.54; 95% CI, 1.28-5.06; p=0.008), toe wounds (HR 
      0.29; 95% CI, 0.094-0.88; p=0.029), and visible blood flow to the wound (HR 0.43; 
      95% CI, 0.21-0.89; p=0.023) were associated with MA. We assigned 1 point for 
      positive predictors of MA, hemodialysis, and fI3; 1 point was deducted for 
      negative predictors of MA, toe wounds, and visible blood flow to the wound. A 
      score of -2 or -1, was defined as the low-risk group, 0 was defined as the 
      intermediate-risk group, and +1 or +2 were defined as the high-risk group. At 1 
      year, MA free rate, wound healing rate, and amputation-free survival rate were 
      stratified according to a scoring model. MA free rate was 96.6% in low-risk, 
      72.4% in intermediate-risk, and 67.3% in high-risk (p<0.001); wound healing rate 
      was 67.8% in low-risk, 27.6% in intermediate-risk, and 4.1% in high-risk 
      (p<0.001); amputation-free survival rate was 65.3% in low-risk, 44.8% in 
      intermediate-risk, and 18.4% in high-risk (p<0.001). CONCLUSIONS: The scoring 
      model based on the predictors of MA stratified clinical outcomes in CLTI patients 
      at WIfI clinical stage 4.
FAU - Kobayashi, Norihiro
AU  - Kobayashi N
AUID- ORCID: 0000-0003-1254-0621
AD  - Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, 
      Japan.
FAU - Yamawaki, Masahiro
AU  - Yamawaki M
AD  - Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, 
      Japan.
FAU - Mori, Shinsuke
AU  - Mori S
AUID- ORCID: 0000-0001-9037-867X
AD  - Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, 
      Japan.
FAU - Tsutsumi, Masakazu
AU  - Tsutsumi M
AD  - Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, 
      Japan.
FAU - Honda, Yohsuke
AU  - Honda Y
AUID- ORCID: 0000-0002-0654-1858
AD  - Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, 
      Japan.
FAU - Makino, Kenji
AU  - Makino K
AD  - Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, 
      Japan.
FAU - Shirai, Shigemitsu
AU  - Shirai S
AD  - Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, 
      Japan.
FAU - Mizusawa, Masafumi
AU  - Mizusawa M
AD  - Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, 
      Japan.
FAU - Nakano, Takahide
AU  - Nakano T
AD  - Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, 
      Japan.
FAU - Ito, Yoshiaki
AU  - Ito Y
AD  - Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, 
      Japan.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20211120
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
CIN - J Endovasc Ther. 2023 Jun;30(3):477-478. PMID: 35287512
MH  - Chronic Limb-Threatening Ischemia
MH  - *Endovascular Procedures/adverse effects
MH  - Humans
MH  - Ischemia/diagnostic imaging/surgery
MH  - Kaplan-Meier Estimate
MH  - Limb Salvage/adverse effects
MH  - *Peripheral Arterial Disease/diagnostic imaging/surgery
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Wound Infection/surgery
OTO - NOTNLM
OT  - and foot infection classification
OT  - chronic limb-threatening ischemia
OT  - endovascular therapy
OT  - ischemia
OT  - major amputation
OT  - wound
OT  - wound healing
EDAT- 2021/11/23 06:00
MHDA- 2022/07/12 06:00
CRDT- 2021/11/22 05:33
PHST- 2021/11/23 06:00 [pubmed]
PHST- 2022/07/12 06:00 [medline]
PHST- 2021/11/22 05:33 [entrez]
AID - 10.1177/15266028211059453 [doi]
PST - ppublish
SO  - J Endovasc Ther. 2022 Aug;29(4):594-601. doi: 10.1177/15266028211059453. Epub 
      2021 Nov 20.