PMID- 35850162 OWN - NLM STAT- MEDLINE DCOM- 20221123 LR - 20221221 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 76 IP - 6 DP - 2022 Dec TI - Pedal arterial calcification score is associated with hemodynamic change and major amputation after infrainguinal revascularization for chronic limb-threatening ischemia. PG - 1688-1697.e3 LID - S0741-5214(22)01883-3 [pii] LID - 10.1016/j.jvs.2022.07.009 [doi] AB - OBJECTIVE: Pedal medial arterial calcification (pMAC) is associated with major amputation in patients with chronic limb-threatening ischemia (CLTI). We hypothesize that this association would be related to unresolved distal ischemia. We investigated relationships across pMAC score, hemodynamic change, and major amputation after infrainguinal revascularization for CLTI. METHODS: This is a single-institution, retrospective study of 306 patients who underwent technically successful infrainguinal revascularization for CLTI (2011-2020) and had foot x-rays for blinded pMAC scoring (0-5). A total of 136 (44%) patients had toe pressure measurements performed within 90 days before and 60 days after revascularization. Ischemia grade (0-3) was assigned using the Society for Vascular Surgery Wound, Ischemia, foot Infection (WIfI) system. RESULTS: The revascularization approach was open bypass in 118 (38%) and endovascular in 188 (62%) patients. pMAC scores were trichotomized (0-1 [125; 41%], 2-4 [116; 38%], 5 [65; 21%]). Post-revascularization WIfI ischemia grade was improved in 78 of 136 (57%) and unchanged/worsened in 58 of 136 (43%). A lower pMAC score was associated with hemodynamic improvement (P = .004). Failure to improve the ischemia grade was associated with major amputation (P = .0002). In the endovascular subgroup, WIfI ischemia grade was improved in 43 of 90 (48%) with available measurements, and 37 of 188 (20%) underwent major amputation. In a multivariate logistic model, pMAC 5 was the only factor independently associated with unimproved ischemia grade after endovascular treatment (odds ratio: 4.0 [1.1-16.6], P = .04). In a Cox proportional hazards model, factors independently associated with major amputation after endoluminal revascularization were WIfI stage 4 (hazard ratio [HR]: 2.7 [1.3-5.7], P = .007) and pMAC score (pMAC: 2-4: HR: 10.6 [1.4-80.7], P = .02; pMAC: 5: HR: 15.5 [2.0-119], P = .008). In the bypass subgroup, WIfI ischemia grade was improved in 35 of 46 (76%) with available measurements but was not associated with pMAC score (P = .88) or any other baseline patient or limb characteristics. A total of 19 of 118 (16%) patients underwent major amputation. In a Cox proportional hazards model including bypass conduit, WIfI stage, and pMAC score, the only factor independently associated with major amputation after bypass was use of nonautologous conduit (HR: 5.6 [1.8-17.6], P = .003). CONCLUSIONS: The pMAC score is independently associated with persistent distal ischemia and major amputation after technically successful revascularization for CLTI. These data suggest that pMAC may be a marker for hemodynamic response to revascularization and risk of limb loss, and it may have a stronger influence on the outcome of endoluminal interventions. CI - Copyright (c) 2022 The Authors. Published by Elsevier Inc. All rights reserved. FAU - Liu, Iris H AU - Liu IH AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA. FAU - Wu, Bian AU - Wu B AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA. FAU - Krepkiy, Viktoriya AU - Krepkiy V AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA. FAU - El Khoury, Rym AU - El Khoury R AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA. FAU - Ferraresi, Roberto AU - Ferraresi R AD - Diabetic Foot Center, Clinica San Carlo, Paderno Dugnano, Milan, Italy. FAU - Reyzelman, Alexander M AU - Reyzelman AM AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA. FAU - Hiramoto, Jade S AU - Hiramoto JS AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA. FAU - Schneider, Peter A AU - Schneider PA AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA. FAU - Conte, Michael S AU - Conte MS AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA. FAU - Vartanian, Shant M AU - Vartanian SM AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA. Electronic address: Shant.Vartanian@ucsf.edu. LA - eng PT - Journal Article DEP - 20220716 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM CIN - J Vasc Surg. 2022 Dec;76(6):1698. PMID: 36410849 MH - Humans MH - Limb Salvage MH - *Peripheral Arterial Disease/diagnostic imaging/surgery MH - Retrospective Studies MH - Chronic Limb-Threatening Ischemia MH - Risk Factors MH - Treatment Outcome MH - Time Factors MH - Amputation, Surgical MH - Vascular Surgical Procedures MH - Ischemia/diagnostic imaging/surgery MH - Hemodynamics MH - *Endovascular Procedures/adverse effects OTO - NOTNLM OT - Amputation OT - Chronic limb-threatening ischemia OT - Monckeberg medial calcific sclerosis OT - Peripheral arterial disease OT - Vascular calcification EDAT- 2022/07/20 06:00 MHDA- 2022/11/24 06:00 CRDT- 2022/07/19 07:22 PHST- 2022/01/04 00:00 [received] PHST- 2022/07/01 00:00 [revised] PHST- 2022/07/02 00:00 [accepted] PHST- 2022/07/20 06:00 [pubmed] PHST- 2022/11/24 06:00 [medline] PHST- 2022/07/19 07:22 [entrez] AID - S0741-5214(22)01883-3 [pii] AID - 10.1016/j.jvs.2022.07.009 [doi] PST - ppublish SO - J Vasc Surg. 2022 Dec;76(6):1688-1697.e3. doi: 10.1016/j.jvs.2022.07.009. Epub 2022 Jul 16.