Prediction of Limb Salvage Following Percutaneous Vascular Intervention Using a Composite Tibial Artery Perfusion Score

Journal Article · Thu Aug 15 04:00:00 EDT 2019 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-019-02223-8· OSTI ID:22969204

Bai, Harrison X.; Davis, Andrew J. O. ^[1]; Mantell, Mark P. ^[2]; Troiano, Michael A. ^[3]; Brandis, Aaron W.; Redmond, Jonas R. B.; Clark, Timothy W. I., ^[1]

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1. Perelman School of Medicine, University of Pennsylvania, Section of Interventional Radiology, Department of Radiology, Penn Presbyterian Medical Center (United States)
2. University of Pennsylvania, Division of Vascular Surgery, Department of Surgery, Penn Presbyterian Medical Center (United States)
3. University of Pennsylvania, Department of Podiatry, Penn Presbyterian Medical Center (United States)

Purpose: To assess a novel tibial artery perfusion score (TPS) for predicting limb salvage in critical limb ischemia (CLI) patients undergoing percutaneous vascular intervention (PVI). Patients and Methods: 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. Results: 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. Conclusions: 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 of Evidence: Level IV, case series.

• OSTI ID: 22969204
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 8 Vol. 42; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ARTERIES
BONE JOINTS
BYPASSES
ISCHEMIA
LIMBS
MEDICAL SURVEILLANCE
PATENTS
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SURGERY