PMID- 36870562
OWN - NLM
STAT- MEDLINE
DCOM- 20230804
LR  - 20230804
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 94
DP  - 2023 Aug
TI  - Risk Factors for Major Amputation in Chronic Limb-Threatening Ischemia Patients 
      Classified as Wound, Ischemia, and Foot Infection Stage 4 following Infrainguinal 
      Revascularization.
PG  - 246-252
LID - S0890-5096(23)00110-3 [pii]
LID - 10.1016/j.avsg.2023.02.010 [doi]
AB  - BACKGROUND: To evaluate limb salvage outcomes and risk factors for major 
      amputation in chronic limb-threatening ischemia (CLTI) patients classified as 
      stage 4 per the wound, ischemia, and foot infection (WIfI) classification 
      following infrainguinal revascularization. METHODS: We retrospectively analyzed 
      multicenter data of patients who had undergone infrainguinal revascularization 
      for CLTI between 2015 and 2020. The endpoint was secondary major amputation 
      defined as an above- or below-knee amputation following infrainguinal 
      revascularization. RESULTS: We analyzed 243 patients with CLTI and 267 limbs. 
      Bypass surgery was performed in 14 (25.5%) and 120 (56.6%) limbs from the 
      secondary major amputation and limb salvage groups, respectively (P < 0.01). 
      Endovascular therapy (EVT) was performed in 41 limbs (74.5%) in the secondary 
      major amputation group and 92 limbs (43.4%) in the limb salvage group (P < 0.01). 
      The average serum albumin levels were 3.0 +/- 0.6 and 3.4 +/- 0.5 g/dL in the 
      secondary major amputation and limb salvage groups, respectively (P < 0.01). The 
      percentage of congestive heart failure (CHF) was 36.4% and 14.2% in secondary 
      major amputation and limb salvage groups, respectively (P < 0.01). The number of 
      limbs with infra-malleolar (IM) P0, P1, and P2 were 4 (7.3%), 37 (67.3%), and 14 
      (25.5%), respectively, in the secondary major amputation group and 58 (27.4%), 
      140 (66.0%), and 14 (6.6%), respectively, in the limb salvage group (P < 0.01). 
      Limb salvage rates at 1 year were 91.0% and 68.6% in the bypass and EVT groups, 
      respectively (P < 0.01). Limb salvage rates at 1 year in patients with IM P0, P1, 
      and P2 were 91.8%, 79.9%, and 53.1%, respectively (P < 0.01). Multivariate 
      analysis revealed that serum albumin level [hazard ratio (HR), 0.56; 95% 
      confidence interval (CI), 0.36-0.89; P = 0.01], hypertension (HR, 0.39; 95% CI, 
      0.21-0.75; P < 0.01), CHF (HR, 2.10; 95% CI, 1.09-4.05; P = 0.03), wound grade 
      (HR, 1.72; 95% CI, 1.03-2.88; P = 0.04), IM P (HR, 2.08; 95% CI, 1.27-3.42; 
      P < 0.01), and EVT (HR, 3.31; 95% CI, 1.77-6.18; P < 0.01) as independent risk 
      factors for secondary major amputation being required. CONCLUSIONS: Among CLTI 
      patients with WIfI stage 4, the limb salvage rate was poor in those with IM P1-2 
      following infrainguinal EVT. Low serum albumin levels, CHF, high wound grade, IM 
      P1-2, and EVT were independent risk factors for CLTI patients requiring major 
      amputation.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Morisaki, Koichi
AU  - Morisaki K
AD  - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu 
      University, Fukuoka, Japan. Electronic address: 
      morisaki.koichi.533@m.kyushu-u.ac.jp.
FAU - Guntani, Atsushi
AU  - Guntani A
AD  - Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, 
      Japan.
FAU - Matsuda, Daisuke
AU  - Matsuda D
AD  - Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.
FAU - Matsubara, Yutaka
AU  - Matsubara Y
AD  - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu 
      University, Fukuoka, Japan.
FAU - Kinoshita, Go
AU  - Kinoshita G
AD  - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu 
      University, Fukuoka, Japan.
FAU - Kawanami, Shogo
AU  - Kawanami S
AD  - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu 
      University, Fukuoka, Japan.
FAU - Yamashita, Sho
AU  - Yamashita S
AD  - Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, 
      Japan.
FAU - Honma, Kenichi
AU  - Honma K
AD  - Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.
FAU - Yamaoka, Terutoshi
AU  - Yamaoka T
AD  - Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.
FAU - Mii, Shinsuke
AU  - Mii S
AD  - Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, 
      Japan.
FAU - Komori, Kimihiro
AU  - Komori K
AD  - Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, 
      Japan.
FAU - Furuyama, Tadashi
AU  - Furuyama T
AD  - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu 
      University, Fukuoka, Japan.
FAU - Yoshizumi, Tomoharu
AU  - Yoshizumi T
AD  - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu 
      University, Fukuoka, Japan.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20230302
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
RN  - 0 (Serum Albumin)
SB  - IM
MH  - Humans
MH  - Chronic Limb-Threatening Ischemia
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - *Peripheral Arterial Disease/diagnostic imaging/surgery/etiology
MH  - Risk Factors
MH  - Limb Salvage/adverse effects
MH  - Amputation, Surgical
MH  - Ischemia/diagnostic imaging/surgery/etiology
MH  - Serum Albumin
MH  - *Endovascular Procedures/adverse effects
EDAT- 2023/03/05 06:00
MHDA- 2023/08/04 06:42
CRDT- 2023/03/04 19:32
PHST- 2022/11/30 00:00 [received]
PHST- 2023/01/09 00:00 [revised]
PHST- 2023/02/03 00:00 [accepted]
PHST- 2023/08/04 06:42 [medline]
PHST- 2023/03/05 06:00 [pubmed]
PHST- 2023/03/04 19:32 [entrez]
AID - S0890-5096(23)00110-3 [pii]
AID - 10.1016/j.avsg.2023.02.010 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2023 Aug;94:246-252. doi: 10.1016/j.avsg.2023.02.010. Epub 2023 
      Mar 2.