Document Detail


Predictors of failure and success of tibial interventions for critical limb ischemia.
MedLine Citation:
PMID:  20619586     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The efficacy of tibial artery endovascular intervention (TAEI) for critical limb ischemia (CLI) and particularly for wound healing is not fully defined. The purpose of this study is to determine predictors of failure and success for TAEI in the setting of CLI.
METHODS: All TAEI for tissue loss or rest pain (Rutherford classes 4, 5, and 6) from 2004 to 2008 were retrospectively reviewed. Clinical outcomes and patency rates were analyzed by multivariable Cox proportional hazards regression and life table analysis.
RESULTS: One hundred twenty-three limbs in 111 patients (62% male, mean age 74) were treated. Sixty-seven percent of patients were diabetics, 55% had renal insufficiency, and 21% required hemodialysis. One hundred two limbs (83%) exhibited tissue loss; all others had ischemic rest pain. All patients underwent tibial angioplasty (PTA). Tibial excimer laser atherectomy was performed in 14% of the patients. Interventions were performed on multiple tibial vessels in 20% of limbs. Isolated tibial procedures were performed on 50 limbs (41%), while 73 patients had concurrent ipsilateral superficial femoral artery or popliteal interventions. The mean distal popliteal and tibial runoff score improved from 11.8 ± 3.6 to 6.7 ± 1.6 (P < .001), and the mean ankle-brachial index increased from 0.61 ± 0.26 to 0.85 ± 0.22 (P < .001). Surgical bypass was required in seven patients (6%). The mean follow up was 6.8 ± 6.6 months, while the 1-year primary, primary-assisted, and secondary patency rates were 33%, 50%, and 56% respectively. Limb salvage rate at 1 year was 75%. Factors found to be associated with impaired limb salvage included renal insufficiency (hazard ratio [HR] = 5.7; P = .03) and the need for pedal intervention (HR = 13.75; P = .04). TAEI in an isolated peroneal artery (odds ratio = 7.80; P = .01) was associated with impaired wound healing, whereas multilevel intervention (HR = 2.1; P = .009) and tibial laser atherectomy (HR = 3.1; P = .01) were predictors of wound healing. In patients with tissue loss, 41% achieved complete closure (mean time to healing, 10.7 ± 7.4 months), and 39% exhibited partial wound healing (mean follow up, 4.4 ± 4.8 months) at last follow up. Diabetes, smoking, statin therapy, and revascularization of > 1 tibial vessel had no impact on limb salvage or wound healing. Re-intervention rate was 50% at 1 year.
CONCLUSIONS: TAEI is an effective treatment for CLI with acceptable limb salvage and wound healing rates, but requires a high rate of reintervention. Patients with renal failure, pedal disease, or isolated peroneal runoff have poor outcomes with TAEI and should be considered for surgical bypass.
Authors:
Nathan Fernandez; Ryan McEnaney; Luke K Marone; Robert Y Rhee; Steven Leers; Michel Makaroun; Rabih A Chaer
Related Documents :
3438216 - Cerebral palsy spasticity. selective posterior rhizotomy.
19955896 - Train of four responses in paretic limbs.
10959506 - Nomograms used to define the short-term treatment with pge(1) in patients with intermit...
24740496 - Low energy intake during the first week in an emergency intensive care unit is associat...
20173366 - Experience with various types of orthotopic neobladder in japanese men: long-term follo...
16173246 - Inclusion criteria as widely used for rheumatoid arthritis clinical trials: patient eli...
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  52     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-04     Completed Date:  2010-10-28     Revised Date:  2014-01-29    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  834-42     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty* / adverse effects
Ankle Brachial Index
Atherectomy* / adverse effects,  instrumentation
Critical Illness
Female
Humans
Ischemia / physiopathology,  therapy*
Kaplan-Meier Estimate
Lasers, Excimer
Life Tables
Limb Salvage
Lower Extremity / blood supply*
Male
Middle Aged
Odds Ratio
Patient Selection
Pennsylvania
Proportional Hazards Models
Renal Insufficiency / complications
Retrospective Studies
Risk Assessment
Risk Factors
Tibial Arteries* / physiopathology
Time Factors
Treatment Failure
Vascular Patency
Wound Healing
Grant Support
ID/Acronym/Agency:
T32 HL098036/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Accuracy of duplex sonography scans after renal artery stenting.
Next Document:  Dilated aortic root is related to a global aortic dilating diathesis.