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Rodway AD, Hanna L, Harris J, Jarrett R, Allan C, Pazos Casal F, Field BC, Whyte MB, Ntagiantas N, Walton I, Pankhania A, Skene SS, Maytham GD, Heiss C. Prognostic and predictive value of ultrasound-based estimated ankle brachial pressure index at early follow-up after endovascular revascularization of chronic limb-threatening ischaemia: a prospective, single-centre, service evaluation. EClinicalMedicine 2024; 68:102410. [PMID: 38273891 PMCID: PMC10809069 DOI: 10.1016/j.eclinm.2023.102410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Background Ankle brachial pressure index can be estimated (eABPI) using cuffless ankle Doppler ultrasound. We evaluated the prognostic value of eABPI measured during pre- and post-procedural ultrasound exams to predict the clinical outcome after endovascular revascularisations. Methods In this prospective, single-centre, service evaluation, consecutive patients with symptomatic peripheral artery disease undergoing lower limb endovascular revascularisations between July, 26 2018 and January, 13 2022 at Surrey and Sussex Healthcare NHS Trust (Redhill, UK) were analysed. eABPI was determined using the higher acceleration index measured with angle-corrected duplex ultrasound in ankle arteries before and ≤1 month post-procedure. Clinical outcomes (mortality, major amputations, amputation-free survival [AFS], clinically driven target lesion revascularization [cdTLR], major adverse limb events [MALE; cdTLR and major amputation], wound healing) were assessed over 1 year. Findings Of 246 patients treated, for 219 patients (median 75 [IQR 66-83] years) pre- and post-procedural eABPI (0.50 [0.33-0.59] and 0.90 [0.69-1.0], p < 0.0001) were available, respectively. In n = 199 patients with chronic limb-threatening ischaemia (CLTI) Kaplan-Meier survival analyses showed that higher post-procedural, but not pre-procedural, eABPI was associated with favourable AFS, MALE, cdTLR, and wound healing. This was confirmed in Cox regression analysis and remained significant with adjustment for pre-procedural eABPI, age, sex, co-morbidities, treated levels, wound score, and foot infection. Whereas all clinical outcomes, except for survival, were significantly better at ≥0.7 vs <0.7, wound healing (unadjusted: HR 1.7 (95% CI 1.2-2.6), adjusted: HR 2.1 (95% CI 1.3-3.1), cdTLR, and MALE (unadjusted: HR 0.41 (95% CI 0.18-0.93), adjusted: HR 0.28 (95% CI 0.11-0.74) were significantly improved at ≥0.9 vs <0.9. Interpretation Post-procedural eABPI can provide valid, clinically important prognostic and predictive information. Our data indicate that revascularisations should target values of at least 0.9 to achieve optimal outcomes. Future studies need to confirm generalisability and cost-effectiveness in a wider context. Funding European Partnership on Metrology, co-financed from European Union's Horizon Europe Research and Innovation Programme and UK Research and Innovation.
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Affiliation(s)
- Alexander D. Rodway
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Jenny Harris
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Rachael Jarrett
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Charlotte Allan
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Felipe Pazos Casal
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Benjamin C.T. Field
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Martin B. Whyte
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Nikolaos Ntagiantas
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Ivan Walton
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Ajay Pankhania
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Simon S. Skene
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Gary D. Maytham
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Christian Heiss
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
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Rodway AD, Harris J, Hanna L, Allan C, Casal FP, Giltinan C, Dehghan-Nayeri A, Santos A, Whyte MB, Ntagiantas N, Walton I, Brown R, Skene SS, Pankhania A, Field BCT, Maytham GD, Heiss C. Understanding the Impact of COVID-19 on Angioplasty Service and Outcome of Patients Treated for Chronic Limb-Threatening Ischaemia: A Single-Centre Retrospective Cohort Study. Biomedicines 2023; 11:2034. [PMID: 37509673 PMCID: PMC10377405 DOI: 10.3390/biomedicines11072034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
We evaluated the impact of COVID-19 restriction on the angioplasty service and outcome of chronic limb-threatening ischaemia (CLTI) patients undergoing lower-limb angioplasty in a UK secondary care setting. Consecutive patients were analysed retrospectively. Pre-COVID-19 (08/2018-02/2020), 106 CLTI patients (91% Fontaine 4; 60% diabetes mellitus) and during COVID-19 (03/2020-07/2021) 94 patients were treated (86% Fontaine 4; 66% diabetes mellitus). While the average monthly number of patients treated did not change, the proportion of day cases significantly increased (53% to 80%), and hospitalised patients decreased. Patients treated in ≤14/5 days after referral significantly increased to 64/63%. Kaplan-Meier survival analysis (30-day/1-year) showed that neither wound healing nor mortality were significantly changed during COVID-19. In day cases, 1-year but not 30-day major amputations significantly increased, and clinically driven target-lesion revascularisation decreased during COVID-19. One-year mortality was significantly worse in hospitalised compared to day cases (14% vs. 43%) at similar wound healing rates (83% vs. 84%). The most frequent known cause of death was infectious disease (64%), while cardiovascular (21%) was less frequent. Despite COVID-19 restrictions, a safe and effective angioplasty service was maintained while shortening waiting times. Very high mortality rates in hospitalised patients may indicate that CLTI patients need to be referred and treated more aggressively earlier.
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Affiliation(s)
- Alexander D Rodway
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
- Department of Vascular Surgery, University Hospital Sussex NHS Trust, Brighton BN2 5BE, UK
| | - Jenny Harris
- Department of Adult Nursing, School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Lydia Hanna
- Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London SW7 2BX, UK
| | - Charlotte Allan
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
| | - Felipe Pazos Casal
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
| | - Ciara Giltinan
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
- Department of Clinical and Experimental Medicine, School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Ali Dehghan-Nayeri
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
- Department of Clinical and Experimental Medicine, School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Andre Santos
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
- Department of Clinical and Experimental Medicine, School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Martin B Whyte
- Department of Clinical and Experimental Medicine, School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Nikolaos Ntagiantas
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
- St. George's Vascular Institute, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Ivan Walton
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
- St. George's Vascular Institute, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Richard Brown
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
| | - Simon S Skene
- Department of Clinical and Experimental Medicine, School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Ajay Pankhania
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
| | - Benjamin C T Field
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
- Department of Clinical and Experimental Medicine, School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Gary D Maytham
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
- St. George's Vascular Institute, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Christian Heiss
- Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK
- Department of Clinical and Experimental Medicine, School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
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Thieme M, Krankenberg H, Schilling T, Betge S, Korosoglou G, Rammos C, Vosseler M, Espinola-Klein C, Heilmeier B, Müller OJ, Langhoff R, Malyar N, Blessing E, Caspary L, Linnemann B, Heiss C, Ito W. Endovascular interventions in outpatient care. VASA 2023; 52:141-146. [PMID: 36935626 DOI: 10.1024/0301-1526/a001067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Endovascular arterial revascularisations for the treatment of symptomatic peripheral arterial disease are constantly increasing in importance and number due to the changing age structure and high numbers of comorbidities in the German population. Patients with peripheral artery disease are often at increased risk for peri- and post-procedural complications including severe cardiovascular events. Due to limited financial and human resources and considerable risks of hospitalization, endovascular interventions that were previously reserved for hospitalized patients are now progressively considered to be performed as day case procedures. More than one third of these procedures are performed in Germany by internists with a specialization in angiology. In the current position paper the German Society of Angiology endorsed by the European Society of Vascular Medicine, summarizes the requirements and risk factors to be considered for the planning, safe performance and post procedural care of endovascular revascularizations in outpatients. The performance of endovascular procedures for peripheral artery disease both in hospitalised and outpatients should be accompanied by a mandatory quality assurance process that should not only capture procedural data, but also require documentation of complications and longterm outcome.
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Affiliation(s)
- Marcus Thieme
- Regiomed Vascular Center and Department of Internal Medicine, REGIOMED-Hospital GmbH, Sonneberg, Germany.,Department of Internal Medicine I, University Hospital Jena, Germany.,School of Medicine, University of Split, Croatia
| | - Hans Krankenberg
- Regiomed Vascular Center and Department of Internal Medicine, REGIOMED-Hospital GmbH, Sonneberg, Germany.,School of Medicine, University of Split, Croatia
| | - Tom Schilling
- Center for Internal Medicine, Harz-Hospital Wernigerode, Germany
| | - Stefan Betge
- Department of Internal Medicine and Angiology, HELIOS-Hospital Salzgitter, Germany
| | | | - Christos Rammos
- Department of Cardiology and Angiology, University Hospital Essen, Germany
| | | | | | | | - Oliver J Müller
- Department of Internal Medicine III, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ralf Langhoff
- Department of Angiology, St. Gertrauden Hospital, Berlin, Germany
| | - Nasser Malyar
- Department of Cardiology I, University Hospital Münster, Germany
| | - Erwin Blessing
- Department of Vascular Medicine, University Hospital Hamburg, Germany
| | | | - Birgit Linnemann
- Department of Angiology, University Vascular Center East Bavaria, University Hospital Regensburg, Germany
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.,Vascular Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Wulf Ito
- Heart and Vascular Center, Allgäu Hospital gGmbH, Immenstadt, Germany
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Heiss C, Olinic DM, Belch JJF, Brodmann M, Mazzolai L, Stanek A, Madaric J, Krentz A, Schlager O, Lichtenberg M, Frank U. Management of chronic peripheral artery disease patients with indication for endovascular revascularization. VASA 2022; 51:121-137. [PMID: 35418243 DOI: 10.1024/0301-1526/a000998] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
With an increasing global burden of patients with chronic peripheral artery disease (PAD) the safe and effective provision of lower limb revascularisation is a growing medical need. Endovascular procedures for the treatment of PAD have become a crucial cornerstone of modern vascular medicine, and the first line revascularisation approach if technically feasible and taking patient choice into consideration. With the increasing age of patients with PAD and the increasing number of comorbidities open vascular surgery is also often not feasible. We outline a framework of key messages, endorsed by the board of the European Society of Vascular Medicine for pre-, peri- and post procedural management of patients requiring endovascular arterial procedures of the lower limbs. These key messages emphasize the important and increasing role of interventional vascular physicians.
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Affiliation(s)
- Christian Heiss
- Department of Clinical and Experimental Medicine, University of Surrey, Faculty of Health and Medical Sciences, Guildford, United Kingdom.,Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom.,The authors contributed equally
| | - Dan-Mircea Olinic
- Iuliu Hatieganu University of Medicine and Pharmacy, Emergency Hospital, Medical Clinic no. 1, Cluj-Napoca, Romania.,The authors contributed equally
| | - Jill J F Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Agata Stanek
- Department of Internal Diseases, Angiology and Physical Medicine, Medical University of Silesia, Bytom, Poland
| | - Juraj Madaric
- Clinic of Angiology, National Cardiovascular Institute, Bratislava, Slovakia
| | - Andrew Krentz
- Institute for Cardiovascular & Metabolic Research, University of Reading, UK
| | - Oliver Schlager
- Division of Angiology. Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Ulrich Frank
- Department of Angiology, Cantonal Hospital of Grisons, Chur, Switzerland.,The authors contributed equally
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