lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

Prognostic and Predictive Value of Ultrasound-Based Estimated Ankle Brachial Pressure Index at Early Follow-Up after Endovascular Revascularization of Lower Limb Peripheral Artery Disease

15 Pages Posted: 31 Aug 2023

See all articles by Alexander Rodway

Alexander Rodway

Surrey and Sussex Healthcare NHS Trust

Lydia Hanna

Imperial College London - Imperial College Healthcare NHS Trust

Jenny Harris

University of Surrey

Rachael Jarrett

Surrey and Sussex Healthcare NHS Trust

Charlotte Allan

Surrey and Sussex Healthcare NHS Trust

Felipe Pazos Casal

Surrey and Sussex Healthcare NHS Trust

Benjamin C.T. Field

Surrey and Sussex Healthcare NHS Trust

Martin B. Whyte

Surrey and Sussex Healthcare NHS Trust

Nikolaos Ntagiantas

Surrey and Sussex Healthcare NHS Trust

Ivan Walton

Surrey and Sussex Healthcare NHS Trust

Ajay Pankhania

Surrey and Sussex Healthcare NHS Trust

Simon S. Skene

University of Surrey - Surrey Clinical Research Centre

Gary D. Maytham

Surrey and Sussex Healthcare NHS Trust

Christian Heiss

Surrey and Sussex Healthcare NHS Trust

More...

Abstract

Background: Ankle brachial pressure index can be estimated (eABPI) using cuffless ankle Doppler. We evaluated the prognostic value of eABPI measured during pre- and post-procedural ultrasound exams to predict the clinical outcome of endovascular revascularisations.

Methods: A cohort of consecutive patients with symptomatic peripheral artery disease undergoing lower limb endovascular revascularisations were analysed as part of prospectively service evaluation in a UK National Health Service Trust. eABPI was determined using the higher acceleration index measured with angle-corrected duplex ultrasound in ankle arteries before and ≤1 month post-surgery. Clinical outcomes (mortality, major amputations, amputation-free survival [AFS], clinically-driven target lesion revascularization [cdTLR], major adverse limb events [MALE; cdTLR, major amputation], wound healing) were assessed over one year.

Findings: In 215 patients (74±11 years) pre- and post-procedural eABPI (0.45±0.23 and 0.84±0.21, p<0.001) were available, respectively. 194 (91%) had chronic limb-threatening ischaemia (CLTI; Fontaine III 10%, IV 81%). Kaplan-Meier survival analyses were performed in patients with CLTI, by quartiles of eABPI (Q1 [Range: 0.20-0.69], Q2 [0.70-0.87], Q3 [0.90-0.99], Q4 [1.00-1.22]). The lowest post-procedural eABPI quartile (Q1) showed lower AFS (Q1: 60%, Q2: 85%, Q3: 78%, Q4: 81%; p=0.007) and higher MALE (Q1: 27%, Q2: 9%, Q3: 5%, Q4: 10%; p=0.002) and cdTLR (Q1: 16%, Q2: 7%, Q3: 0%, Q4: 7%; p=0.021). Wound healing was lower in the Q1&Q2 groups with post-procedural eABPI <0.9 (Q1: 62%, Q2: 72%, Q3: 95%, Q4: 89%; p=0.008). No outcomes differed between pre-procedural eABPI quartiles.

Interpretation: Post-procedural eABPI provides valid, clinically important prognostic and predictive information. Revascularisations should target eABPI  ≥0.7 for optimal outcomes.

Funding: C.H. has received funding from 22HLT01 QUMPHY. The project (22HLT01 QUMPHY) has received funding from the European Partnership on Metrology, co-financed from the European Union’s Horizon Europe Research and Innovation Programme and by the Participating States.

Declaration of Interest: The authors declare that there is no conflict of interest.

Ethical Approval:All measurements were conducted as part of routine clinical care within a National Health Service acute hospital in the UK. The confidentiality of patient data was strictly observed, and only anonymised data were analysed. As a service evaluation, there was no requirement for research ethics committee approval. Patient consent was waived as this was part of a service evaluation without the requirement for research ethics committee approval.

Keywords: chronic limb-threatening ischaemia, peripheral artery disease, angioplasty, estimated ankle brachial pressure index, biomarker

Suggested Citation

Rodway, Alexander and Hanna, Lydia and Harris, Jenny and Jarrett, Rachael and Allan, Charlotte and Pazos Casal, Felipe and Field, Benjamin C.T. and Whyte, Martin B. and Ntagiantas, Nikolaos and Walton, Ivan and Pankhania, Ajay and Skene, Simon S. and Maytham, Gary D. and Heiss, Christian, Prognostic and Predictive Value of Ultrasound-Based Estimated Ankle Brachial Pressure Index at Early Follow-Up after Endovascular Revascularization of Lower Limb Peripheral Artery Disease. Available at SSRN: https://ssrn.com/abstract=4551967 or http://dx.doi.org/10.2139/ssrn.4551967

Alexander Rodway

Surrey and Sussex Healthcare NHS Trust ( email )

Lydia Hanna

Imperial College London - Imperial College Healthcare NHS Trust ( email )

Praed St
London
United Kingdom

Jenny Harris

University of Surrey ( email )

Rachael Jarrett

Surrey and Sussex Healthcare NHS Trust ( email )

Charlotte Allan

Surrey and Sussex Healthcare NHS Trust ( email )

Felipe Pazos Casal

Surrey and Sussex Healthcare NHS Trust ( email )

Benjamin C.T. Field

Surrey and Sussex Healthcare NHS Trust ( email )

Martin B. Whyte

Surrey and Sussex Healthcare NHS Trust ( email )

Nikolaos Ntagiantas

Surrey and Sussex Healthcare NHS Trust ( email )

Ivan Walton

Surrey and Sussex Healthcare NHS Trust ( email )

Ajay Pankhania

Surrey and Sussex Healthcare NHS Trust ( email )

Simon S. Skene

University of Surrey - Surrey Clinical Research Centre ( email )

Gary D. Maytham

Surrey and Sussex Healthcare NHS Trust ( email )

Christian Heiss (Contact Author)

Surrey and Sussex Healthcare NHS Trust ( email )