Competing Risk Analysis of the Impact of Pedal Arch Status and Angiosome-Targeted Revascularization in Chronic Limb-Threatening Ischemia
| Autor: | Nicla Settembre, Maria Söderström, Fausto Biancari, Maarit Venermo, Kristyna Spillerova, Anders Albäck |
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| Přispěvatelé: | HUS Abdominal Center, Department of Surgery, Verisuonikirurgian yksikkö, University of Helsinki, Helsinki University Hospital Area |
| Rok vydání: | 2020 |
| Předmět: |
Male
Time Factors medicine.medical_treatment angiosome 030204 cardiovascular system & hematology 030218 nuclear medicine & medical imaging 0302 clinical medicine Ischemia Risk Factors Registries Foot Ulcer bypass Gangrene Aged 80 and over OUTCOMES Endovascular Procedures General Medicine Middle Aged Limb Salvage Treatment Outcome BYPASS-SURGERY cardiovascular system Cardiology Female Cardiology and Cardiovascular Medicine Risk assessment Vascular Surgical Procedures medicine.medical_specialty Context (language use) percutaneous transluminal angioplasty Lower risk Revascularization Risk Assessment Amputation Surgical pedal arch 03 medical and health sciences Peripheral Arterial Disease amputation Internal medicine SCORE medicine Humans cardiovascular diseases ANGIOPLASTY Vascular Patency Aged Retrospective Studies business.industry Foot competing risk analysis Retrospective cohort study 3126 Surgery anesthesiology intensive care radiology medicine.disease Confidence interval body regions Chronic Disease Surgery business |
| Zdroj: | Annals of vascular surgery. 68 |
| ISSN: | 1615-5947 |
| Popis: | Background In the context of chronic limb-threatening ischemia, the prognostic impact of angiosome-targeted revascularization and of the status of the pedal arch are debated. Methods This series includes 580 patients who underwent endovascular (n = 407) and surgical revascularization (n = 173) of the infrapopliteal arteries for chronic limb-threatening ischemia associated with foot ulcer or gangrene. The risk of major amputation after infrapopliteal revascularization was assessed by a competing risk approach. A subanalysis was made separately for patients who underwent endovascular or open surgical revascularization. Results At 2 years, survival was 65.1% and leg salvage was 76.1%. Multivariable competing risk analysis showed that C-reactive protein ≥10 mg/dL, diabetes, rheumatoid arthritis, increased number of affected angiosomes, and the incomplete or total absence of pedal arch compared with complete pedal arch (CPA) were independent predictors of major amputation after infrapopliteal revascularization. Multivariable analysis showed increasing risk estimates of major amputation in patients with incomplete (subdistribution hazard ratio [SHR], 2.131; 95% confidence interval [95% CI], 1.282–3.543) and no visualized pedal arch (SHR, 3.022; 95% CI, 1.553–5.883) compared with CPA. Pedal arch was important even if angiosome-targeted revascularization was achieved: Angiosome-directed revascularization in presence of CPA had a lower risk of major amputation (adjusted SHR, 0.463; 95% CI, 0.240–0.894) compared with angiosome-directed revascularization without CPA. In the subanalysis, among patients who underwent endovascular revascularization, CPA (SHR, 0.509; 95% CI, 0.286–0.905) and angiosome-targeted revascularization (SHR, 0.613; 95% CI, 0.394–0.956) were associated with a lower risk of major amputation. Conclusions Competing risk analysis showed that a patent pedal arch had significant impact on leg salvage and that the subset of patients undergoing endovascular procedure may most benefit of an angiosome-targeted revascularization. |
| Databáze: | OpenAIRE |
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