PMID- 36332807
OWN - NLM
STAT- MEDLINE
DCOM- 20230227
LR  - 20230227
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 77
IP  - 3
DP  - 2023 Mar
TI  - Severe inframalleolar disease is an independent predictor of adverse limb 
      outcomes after endovascular revascularization in chronic limb-threatening 
      ischemia.
PG  - 858-863
LID - S0741-5214(22)02463-6 [pii]
LID - 10.1016/j.jvs.2022.10.042 [doi]
AB  - OBJECTIVE: In the present study, we evaluated the effects of inframalleolar (IM) 
      disease on the occurrence of major adverse limb events (MALE) in patients 
      undergoing endovascular revascularization for chronic limb-threatening ischemia 
      (CLTI). METHODS: Patients who had undergone endovascular revascularization for 
      CLTI between January 2015 and December 2019 at two university-affiliated 
      hospitals were reviewed retrospectively. Patients with severe IM disease (pedal 
      score of 2) were compared with those with mild to moderate IM disease (score of 0 
      or 1) using the Global Vascular Guidelines. The primary outcome was MALE (open 
      revascularization, acute leg ischemia, major amputation). The secondary outcomes 
      were mortality, reintervention, major adverse cardiac events, and perioperative 
      complications </=30 days after endovascular revascularization, primary limb-based 
      patency, and the occurrence of any limb event (defined as any amputation, acute 
      leg ischemia, or open revascularization). Kaplan-Meier estimates were used to 
      compare the primary outcome, and the Cox proportion hazard model was used to 
      assess the effects of IM disease. RESULTS: The study included 167 limbs in 149 
      patients (36% female; mean age, 74 +/- 12 years). Severe IM disease was identified 
      in 71 limbs (43%). No differences were found in the baseline characteristics, 
      except for a higher prevalence of dyslipidemia in the patients with severe IM 
      disease (66% vs 43%; P = .003). Most patients in both groups had had a WIfI 
      (Wound, Ischemia, foot Infection) score of 4 (severe IM disease, 64%; vs mild to 
      moderate IM disease, 57%; P = .462) and GLASS (global limb anatomic severity 
      scale) III anatomy (severe IM disease, 54%; vs mild to moderate IM disease, 48%; 
      P = .752). The Kaplan-Meier estimates showed that severe IM disease was 
      associated with lower freedom from MALE (69% vs 82%; P = .026). The Cox 
      proportion hazard regression model showed that severe IM disease was an 
      independent predictor of increased MALE and amputation risk (hazard ratio, 1.715; 
      95% confidence interval, 1.015-2.896; P = .044) after adjusting for covariates. 
      During follow-up, patients with severe IM disease had had mortality (27% vs 31%; 
      P = .567) and reintervention (42% vs 38%; P = .608) similar to those for patients 
      with mild to moderate IM disease. Primary limb-based patency was also similar 
      (79% vs 84%; P = .593) at a mean follow-up of 3.8 +/- 0.8 years. CONCLUSIONS: 
      Severe IM disease was prevalent in 43% of limbs that had undergone endovascular 
      revascularization for CLTI and was associated with lower freedom from MALE. 
      Severe IM disease also independently increased the hazard of adverse limb 
      outcomes and amputations in patients with CLTI by >70%, highlighting its 
      importance as a measure of foot perfusion.
CI  - Copyright (c) 2022 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Naiem, Ahmed A
AU  - Naiem AA
AD  - Division of Vascular Surgery, McGill University, Montreal, QC, Canada.
FAU - Bergeron, Ariane
AU  - Bergeron A
AD  - Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
FAU - MacKenzie, Kent S
AU  - MacKenzie KS
AD  - Division of Vascular Surgery, McGill University Health Centre, Montreal, QC, 
      Canada.
FAU - Obrand, Daniel I
AU  - Obrand DI
AD  - Division of Vascular Surgery, Jewish General Hospital, Montreal, QC, Canada.
FAU - Steinmetz, Oren K
AU  - Steinmetz OK
AD  - Division of Vascular Surgery, McGill University Health Centre, Montreal, QC, 
      Canada.
FAU - Bayne, Jason P
AU  - Bayne JP
AD  - Division of Vascular Surgery, Jewish General Hospital, Montreal, QC, Canada.
FAU - Gill, Heather L
AU  - Gill HL
AD  - Division of Vascular Surgery, McGill University Health Centre, Montreal, QC, 
      Canada.
FAU - Girsowicz, Elie
AU  - Girsowicz E
AD  - Division of Vascular Surgery, Jewish General Hospital, Montreal, QC, Canada. 
      Electronic address: elie.girsowicz@mcgill.ca.
LA  - eng
PT  - Journal Article
DEP - 20221101
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Humans
MH  - Female
MH  - Middle Aged
MH  - Aged
MH  - Aged, 80 and over
MH  - Male
MH  - Chronic Limb-Threatening Ischemia
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Limb Salvage/adverse effects
MH  - *Peripheral Arterial Disease
MH  - Treatment Outcome
MH  - Ischemia
MH  - Chronic Disease
MH  - *Endovascular Procedures/adverse effects
OTO - NOTNLM
OT  - Chronic limb-threatening ischemia
OT  - Endovascular revascularization
OT  - Inframalleolar disease
EDAT- 2022/11/05 06:00
MHDA- 2023/03/03 06:00
CRDT- 2022/11/04 20:28
PHST- 2022/08/22 00:00 [received]
PHST- 2022/10/14 00:00 [revised]
PHST- 2022/10/19 00:00 [accepted]
PHST- 2022/11/05 06:00 [pubmed]
PHST- 2023/03/03 06:00 [medline]
PHST- 2022/11/04 20:28 [entrez]
AID - S0741-5214(22)02463-6 [pii]
AID - 10.1016/j.jvs.2022.10.042 [doi]
PST - ppublish
SO  - J Vasc Surg. 2023 Mar;77(3):858-863. doi: 10.1016/j.jvs.2022.10.042. Epub 2022 
      Nov 1.