Hemodynamic Assessment Before and After Endovascular Therapy for CLI Studied for Prognostic Value of Outcomes
November 15, 2017—Grant W. Reed, MD, et al published findings from a study on hemodynamic assessment before and after endovascular therapy for critical limb ischemia (CLI) and the association with clinical outcomes. The investigators sought to determine the relationship between the change in ankle-brachial index (ABI) and toe-brachial index (TBI) and outcomes after CLI revascularization. The findings are available online in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.
The background of the study is that an increase in ABI of 0.15 after revascularization for peripheral artery disease with claudication is considered significant. However, the utility of using change in ABI or TBI to predict outcomes in patients with CLI is unproven.
As summarized in JACC: Cardiovascular Interventions, this observational study was composed of 218 patients with Rutherford class 5 or 6 CLI who underwent endovascular therapy. Receiver-operating characteristic curve analysis determined cutpoints in postprocedure ABI and TBI, as well as change in these values for endpoints of wound healing, major adverse limb events (MALEs), and repeat revascularization.
The investigators reported that after multivariable Cox proportional hazards analysis adjusting for age, diabetes, glomerular filtration rate, smoking, Rutherford class, and baseline ABI or TBI, neither static postprocedure ABI nor postprocedure TBI were associated with wound healing (hazard ratio [HR], 1.21; 95% confidence interval [CI], 0.77–1.89; P = .4; HR, 1.49; 95% CI, 0.98–2.27; P = .065, respectively).
However, change in ABI ≥ 0.23 was independently associated with wound healing (HR, 1.87; 95% CI, 1.12–3.15; P = .018) and less repeat revascularization (HR, 0.4; 95% CI, 0.19–0.84; P = .015), but not MALEs. Increase in TBI ≥ 0.21 was independently associated with wound healing (HR, 1.63; 95% CI, 1.02–2.59; P = .039) and reduced MALEs (HR, 0.27; 95% CI, 0.09–0.77; P = .014), but not repeat revascularization.
A change in ABI and TBI from preprocedural values provides prognostic value in determining which patients may have wound healing and reduced MALEs, concluded the investigators in JACC: Cardiovascular Interventions.