clinical impact of multi-vessel infrapopliteal artery … · background & aim results...

Background&Aim Results

Conclusion

ClinicalImpactofMulti-vesselInfrapoplitealArteryRevascularizationStrategyforPatientswithIschemicUlcerations -Sub-analysisfrommulticenterRENDEZVOUSRegistry-

DefinitionofPedalDiseases-Kawaradaclassification-

Methods

◉TatsuyaNakama,MD,NozomiWatanabe,MD,TakuyaHaraguchi,MD,HiroshiSakamoto,MD,DaisukeKamoi,MD,YoshinoriTsubakimoto,MD, KenjiOgata,MD,KatsuhikoSatoh,MD,KazushiUrasawa,MD,HiroshiAndoh,MD,HiroshiFujita,MDandYoshisatoShibata,MD

Multivesselrevascularizationstrategyimprovetherateofwoundhealinginpatientswithischemiculceration(notgangrene),attributedtotibio-pedaldiseases.

Limitation1) Studydesign:sub-analysisformretrospectiveregistry,smallsamplesize2) PedalarteryconditionafterEVTisdifferent3) Patientswithpatentpedalisnotincluded

DisclosureTheauthorshavenofinancialconflictsofinteresttodiscloseconcerningthepresentation.

Abbreviations:ESRD,end-stagerenaldisease;HD,hemodialysis;CAD,coronaryarterydisease;CVD,cerebrovasculardisease;LVEF,leftventricularejectionfraction;SVS,SocietyofVascularSurgery;WiFi;Wound,IschemiaandFootInfection;CRP,C-reactiveprotein;ABI,ankle-brachialindex;EVT,endovasculartherapy;SPP,skinperfusionpressure.Continuousdataarepresentedasthemeans±standarddeviationunlessnotedotherwise;categoricaldataaregivenasthecounts(percentage).

Table1:Patient&limbsbackground

Overall(n=113)

Singlevessel(n=44)

Multivessel(n=69)

Pvalue

ABIbeforeEVT 0.69± 0.33 0.68± 0.33 0.69± 0.33 0.883

ABIafterEVT 0.89± 0.21 0.85± 0.19 0.91± 0.22 0.134

SPP(dorsal)beforeEVT,mmHg 28.6± 20.3 29.9± 21.2 27.9± 20.0 0.649

SPP(plantar)beforeEVT,mmHg 29.6± 17.1 26.8± 15.7 31.2± 17.9 0.218

SPP(dorsal)afterEVT,mmHg 47.8± 21.8 48.4± 18.8 47.6± 23.4 0.866

SPP(plantar)afterEVT,mmHg 46.0± 20.4 42.7± 16.6 47.7± 22.0 0.257

Pureinfrapopliteallesion,n(%) 62(54.9) 23 (52.3) 39(56.6) 0.658

RunoffvesselsbeforeEVT,n 0.86± 0.79 0.80± 0.85 0.90± 0.75 0.513

RunoffvesselsafterEVT, n 2.01± 0.71 1.41± 0.54 2.41±0.49 <0.0001No. ofrecanalizedvessels,n 1.73± 0.71 0.96± 0.21 2.21± 0.42 <0.0001Pedalarterytype2/3beforeEVT 69/44 23/21 46/23 0.269

Pedalarterytype1/2/3afterEVT 31/71/11 4/33/7 27/38/4 0.003

Table2:Hemodynamic&Angiographicfindings<Exclusioncriteria>・Withgangrene (n=144)・FailedEVT(n=12)

One-yearclinicalfollow-up

Primaryoutcomes;Rateofwoundhealing

257patientsWithischemicwounds

PatientswithIschemiculceration(n=113)

Single-VesselRevascularization

(n=44)

Figure:PrimaryoutcomesRateofWoundhealingat1-yearafterprimarytreatment

TimetoWoundhealing(months)

RateofW

ound

healin

g(%

)

0 3 6 9 12

Single-vesselstrategy

43.3%

OnestraightlinestrategyissometimesinsufficientforCLIpatients.Theaimofthisstudywastoevaluatetheclinicalimpactof

Multi-vesselrevascularizationstrategyforpatientswithischemiculcerations,attributedtotibiopedal(infrapopliteal+pedalartery)diseases.

0 3 6 9 12Single-vesselstrategy

at risk 44 30 27 25 22% 0.0 31.8 38.6 40.9 43.3

Multi-vesselstrategy

atrisk 69 43 29 26 20% 0.0 37.7 56.8 61.2 67.3

Standarderrordidnotexceed10%inbothgroups

PatentPedalArtery PedalArteryDiseases(Type2&3)

Overall(n=113)

Singlevessel(n=44)

Multivessel(n=69)

Pvalue

<Patients background>Men,n(%) 77(68.1) 33(75.0) 44(63.8) 0.211Age,years 73.2± 11.2 74.6± 11.7 72.4± 10.8 0.302Non-ambulatory, n(%) 53(46.9) 25(56.8) 28(40.6) 0.092Bodymassindex<18,n(%) 13(11.5) 8(18.2) 5(7.2) 0.076Hypertension,n(%) 76(67.3) 27 (61.4) 49(71.0) 0.286Dyslipidemia,n(%) 41(36.3) 15(34.1) 26(37.7) 0.699Diabetesmellitus,n(%) 79(69.9) 27(61.4) 52(75.4) 0.114Smokinghistory, n(%) 40(35.4) 11 (25.0) 29(42.0) 0.065ESRDonHD,n(%) 66(58.4) 26(59.1) 40(58.0) 0.906HistoryofCAD,n(%) 58(51.3) 23(52.3) 35(50.7) 0.872HistoryofCVD,n(%) 39(34.5) 14(31.8) 25(36.2) 0.630Albuminlevel, g/dl 3.5± 0.5 3.5± 0.5 3.6±0.5 0.339HemoglobinA1c,% 6.6± 1.5 6.2± 1.2 6.8± 1.7 0.025LVEF, % 62.0± 12.0 61.6± 11.3 62.2± 12.6 0.788<Targetlimbsstatus>Rutherfordclass5,n(%) 94(83.2) 39(88.6) 55(79.7) 0.460UniversityofTexas grade>2,n(%) 28(24.8) 12(27.3) 16(23.2) 0.624SVS-WIfICS1/2/3/4, % 6.2/7.1/55.8/31.0 9.1/6.8/54.5/29.5 4.3/7.2/56.5/31.9 0.789WIfIcompositescore 4.5± 1.3 4.5± 1.3 4.6± 1.4 0.637Multipleulceration,n(%) 52(46.0) 31(44.9) 21(47.7) 0.771Woundsize,(>5cm2),n(%) 34(30.1) 11(25.0) 23(33.3) 0.346Woundinfection,n(%) 32(28.3) 12(27.3) 20(29.0) 0.844CRPlevel, mg/dL 1.63± 2.46 2.04± 2.75 1.36± 2.23 0.173Surgicalprocedure,n(%) 36(31.9) 15(34.1) 21(30.4) 0.684

KawaradaO,etal.CatheterCardiovascInterv.2012;80:861–871

NakamaT,etal.JAmCollCardiolInterv2017;10:79-90

Multi-vesselstrategy

67.3%pvalue=0.049

Multi-vesselrevascularization

(n=69)