Abstract 11476: Role of the Completion Angiogram in Predicting Limb Salvage Following Endovascular Therapy in Patients with Critical Limb Ischemia Presenting with Isolated Below-the-Knee Lesions
Backgrounds: Although endovascular therapy (EVT) has become a first-line therapy for limb salvage (LS) in patients with critical limb ischemia (CLI), LS cannot always be predicted by completion angiogram alone. Skin perfusion pressure (SPP)>40 mmHg has been proposed as a strong predictor of wound healing. In this study, we retrospectively analyzed the factors influencing post EVT SPP>40mmHg to predict LS.
Methods: We analyzed 239 limbs from 218 consecutive patients (male=147, age; 70±11 years old) with ischemic ulceration/gangrene, presenting with isolated below the knee lesions (Rutherford 5, 173 limbs and 6, 66 limbs; ankle-brachial index=0.79±0.27 before EVT), who underwent successful EVT, but were not with bypass surgery. We classified these patients into two groups depending on whether SPP>40mmHg was achieved (n=157) or not (n=82). Freedom from amputation (FA) was compared between the groups by Kaplan-Meier analysis and log-lank test. Multivariate analysis was performed to explore the independent determinants of post-EVT SPP>40mmHg.
Results: The overall LS rate was 86% (205/239). LS rate was significantly higher in the SPP>40mmHg group (88±3%) than in the SPP <40mmHg group (70±6%, P=0.04). No-dialysis (P=0.04), statin therapy (P=0.01), lesion without calcification (P=0.003), number of below the knee arteries after EVT (P=0.04), number of below the ankle arteries after EVT (P=0.0005), post-EVT plantar artery patency (P=0.0005), concordant angiosome (P=0.03) were chosen as the independent variables related to limb salvage by single regression analysis. Among these, the number of below the ankle run-off arteries after EVT was the independent factor associated with limb salvage by multivariate analysis.
Conclusions: Number of below the ankle arteries after EVT in completion angiogram was a good predictor of SPP>40mmHg and was related to limb salvage.
- © 2011 by American Heart Association, Inc.