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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
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
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