Prediction of Limb Salvage Following Percutaneous Vascular Intervention Using a Composite Tibial Artery Perfusion Score
| Autor: | Harrison X. Bai, Mark P. Mantell, Timothy Clark, A Brandis, Jonas R. B. Redmond, Andrew J. O. Davis, Michael A. Troiano |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Percutaneous medicine.medical_treatment Kaplan-Meier Estimate Revascularization Risk Assessment Severity of Illness Index Amputation Surgical 030218 nuclear medicine & medical imaging Cohort Studies 03 medical and health sciences 0302 clinical medicine Ischemia Risk Factors medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Prospective cohort study Aged Proportional Hazards Models Peripheral Vascular Diseases Proportional hazards model business.industry Critical limb ischemia Limb Salvage Surgery body regions Tibial Arteries Treatment Outcome Bypass surgery Amputation Lower Extremity Female medicine.symptom Cardiology and Cardiovascular Medicine business Complication Follow-Up Studies |
| Zdroj: | Cardiovascular and interventional radiology. 42(8) |
| ISSN: | 1432-086X |
| Popis: | To assess a novel tibial artery perfusion score (TPS) for predicting limb salvage in critical limb ischemia (CLI) patients undergoing percutaneous vascular intervention (PVI). A consecutive cohort of 115 CLI patients undergoing PVI in 144 limbs from 2011 to 2016 was analyzed. TPS comprised a 27-point scale based on: (1) patent tibial vessels following PVI, (2) severity of calcification of the tibial arteries, (3) presence of an intact pedal arch following intervention, (4) whether or not revascularization was direct or indirect based on the target angiosome, (5) presence of angiosome blush at the completion of index intervention. Limbs were stratified into (1) High [21–27 points], (2) Medium [13–20 points], and (3) Low [0–12 points] TPS. Predictive value of TPS was evaluated using logistic regression and Cox proportional hazards models. The median follow-up was 15.7 months (range 0.4–69.9 months). Limb salvage in High, Medium, and Low TPS groups was 90.6%, 85.9%, and 55.6%, respectively, as freedom from the composite outcome: (1) limb complication resulting in death, (2) tibial bypass surgery, (3) above-the-knee amputation, or (4) below-the-knee amputation in patients without supratibial disease at the time of PVI. TPS was significantly associated with limb salvage defined as freedom from both the composite outcome and major amputation. Based on this preliminary investigation, TPS was associated with limb salvage in CLI limbs, particularly in high-risk limbs. Further validation in a prospective cohort may identify patients with high-risk limbs in need of closer surveillance and earlier reintervention. Level IV, case series. |
| Databáze: | OpenAIRE |
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