Abstract 17765: Hemodynamic Assessment of Macro- and Micro-Perfusion and Clinical Outcomes Following Endovascular Therapy for Critical Limb Ischemia
Background: Ankle-brachial index (ABI) assesses lower extremity macro-perfusion, while toe-brachial index (TBI) assesses micro-perfusion. Whether post-procedure or change in ABI or TBI are associated with outcomes after endovascular therapy for critical limb ischemia (CLI) is unknown.
Methods: This was a prospective study of 306 patients treated with endovascular therapy for CLI. Outcomes were wound healing within 120 days, subsequent percutaneous angioplasty (PTA), or major adverse limb events (MALE – surgical bypass or major amputation). Patients were stratified by median ABI and TBI, and change in ABI cut-points. Cox proportional hazards and Kaplan Meier analyses were utilized.
Results: Both pre- and post-procedure ABI and TBI were available in 263 (86%) and 216 (71%) patients, respectively. A total of 218 (71%) patients had wounds. Among those with compressible ABI, mean ABI increased from 0.58 to 0.80 post-procedure (+Δ0.22; P< 0.0001). TBI increased from 0.18 to 0.29 (+Δ0.11; P< 0.0001). Associations between ABI, TBI, and outcomes are shown in the Table. The likelihood of healing was greater with an increase in ABI ≥ 0.1 (HR 2.25, 95% CI 1.25-4.06; P=0.007). A larger change in ABI (≥ 0.15, 0.2, 0.3, 0.4) was not associated with increased healing above ≥ 0.10 (P=NS comparing cut-points). On Kaplan-Meier analysis, healing was more frequent in patients with increased ABI ≥ 0.1 (P= 0.005; Figure).
Conclusions: An increase in ABI ≥ 0.1 is associated with wound healing after endovascular therapy for CLI. Post-procedure ABI and TBI may be useful in identifying patients at high risk of repeat PTA. Even a small increase in TBI ≥ 0.04 is associated with lower MALE during follow-up.
Author Disclosures: L. Young: None. G.W. Reed: None. I. Bagh: None. M. Shishehbor: None.
- © 2016 by American Heart Association, Inc.