Effects of Infra-malleolar Status According to Global Limb Anatomic Staging System on Clinical Outcomes in Patients With Chronic Limb-Threatening Ischemia

Abstract

The global vascular guideline proposed a novel anatomical classification of infra-malleolar (IM) arterial lesions. We aimed to investigate the association of IM classification with clinical outcomes in patients with chronic limb-threatening ischemia (CLTI) due to isolated infrapopliteal (IP) lesions. We retrospectively analyzed 509 limbs with tissue loss in 357 patients due to isolated IP lesions who underwent endovascular therapy (EVT) between April 2010 and December 2018. The primary outcome was 1-year wound healing rate. The association of patient and anatomic characteristics with non-healing was evaluated using Cox proportional hazards regression analysis. The 1-year cumulative wound healing rate was 59.7%. Multivariable analysis demonstrated that IM grade 2 (hazard ratio [HR], 1.41; P = .044), non-ambulatory status (HR, 1.49; P = .008), hemodialysis (HR, 1.37; P = .020), left ventricular ejection fraction < 50% (HR, 1.72; P = .030), and wound, ischemia, and foot infection (WIfI) classification 4 (HR, 1.33; P = .032) were significantly associated with non-healing, whereas no below-the-ankle (BTA), below-the-knee (BTK) runoff, and Global Limb Anatomic Staging System (GLASS) IP grade had no statistically significant association with non-healing. Global Limb Anatomic Staging System IM grade 2 was an independent risk factor for wound healing in patients who underwent EVT with CLTI due to isolated IP disease.

Keywords

peripheral arterial disease endovascular therapy angiography

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References

Norgren

Hiatt

Dormandy

Nehler

Harris

Fowkes

FGR

. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33:S1–S75.

Reed

Salehi

Giglou

, et al. Time to wound healing and major adverse limb events in patients with critical limb ischemia treated with endovascular revascularization. Ann Vasc Surg. 2016;36:190–198.

Azuma

Koya

Uchida

Saito

Uchida

. Ulcer healing after peripheral intervention-can we predict it before revascularization. Circ J. 2014;78:1791–1800.

Conte

Bradbury

Kolh

, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69:3S–e40.

Aboyans

Ricco

Bartelink

MEL

, et al. ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55:305–368.

Shiraki

Iida

Takahara

, et al. Predictors of delayed wound healing after endovascular therapy of isolated infrapopliteal lesions underlying critical limb ischemia in patients with high prevalence of diabetes mellitus and hemodialysis. Eur J Vasc Endovasc Surg. 2015;49:565–573.

Iida

Nakamura

Yamauchi

, et al. Endovascular treatment for infrainguinal vessels in patients with critical limb ischemia: OLIVE registry, a prospective, multicenter study in Japan with 12-month follow-up. Circ Cardiovasc Interv. 2013;6:68–76.

Hata

Iida

Okamoto

, et al. Additional risk stratification using local and systemic factors for patients with critical limb ischaemia undergoing endovascular therapy in the WIfI era. Eur J Vasc Endovasc Surg. 2019;58:548–555.

Abdelhamid

Davies

Rai

Hopkins

Duddy

Vohra

. Below-the-ankle angioplasty is a feasible and effective intervention for critical leg ischaemia. Eur J Vasc Endovasc Surg. 2010;39:762–768.

10.

Rashid

Slim

Zayed

, et al. The impact of arterial pedal arch quality and angiosome revascularization on foot tissue loss healing and infrapopliteal bypass outcome. J Vasc Surg. 2013;57:1219–1226.

11.

Iida

Nakamura

Yamauchi

, et al. 3-Year outcomes of the OLIVE registry, a prospective multicenter study of patients with critical limb ischemia: a prospective, multi-center, three-year follow-up study on endovascular treatment for infra-inguinal vessel in patients with critical limb ischemia. JACC Cardiovasc Interv. 2015;8:1493–1502.

12.

Jung

Hong

, et al. Impact of endovascular pedal artery revascularisation on wound healing in patients with critical limb ischaemia. Eur J Vasc Endovasc Surg. 2019;58:854–863.

13.

De Athayde Soares

Matielo

Brochado Neto

Martins Cury

Marques

Sacilotto

. Number of infrapopliteal arteries undergoing endovascular treatment is not associated with the limb salvage rate in patients with critical limb ischemia. J Vasc Surg. 2016;64:1344–1350.

14.

Troisi

Turini

Chisci

, et al. Pedal arch patency and not direct-angiosome revascularization predicts outcomes of endovascular interventions in diabetic patients with critical limb ischemia. Int Angiol: A Journal of the International Union of Angiology. 2017;36:438–444.

15.

Mustapha

Anose

Martinsen

, et al. Lower extremity revascularization via endovascular and surgical approaches: A systematic review with emphasis on combined inflow and outflow revascularization. SAGE Open Med. 2020;8:2050312120929239.

16.

Kim

Meshkin

Tirrell

, et al. A systematic review and meta-analysis of endovascular angiosomal revascularization in the setting of collateral vessels. J Vasc Surg. 2021;74:1406.

17.

Iida

Nanto

Uematsu

, et al. Importance of the angiosome concept for endovascular therapy in patients with critical limb ischemia. Catheter Cardiovasc Interv. 2010;75:830–836.

18.

Hata

Iida

Takahara

, et al. Infrapopliteal anatomic severity and delayed wound healing in patients with chronic limb-threatening ischemia in the era of the global limb anatomic staging system. J Endovasc Ther. 2011;27:641–646.

19.

Fernandez

McEnaney

Marone

, et al. Multilevel versus isolated endovascular tibial interventions for critical limb ischemia. J Vasc Surg. 2011;54:722–729.

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