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Karaduman A, Balaban İ, Biyiklı K, Keten MF, Kalkan S, Kahyaoglu M, Celik M, Gecmen Ç. Relationship of the modified Glasgow Prognostic Score with peripheral artery disease severity and procedure success in patients who had undergone endovascular treatment. Vascular 2024:17085381241273281. [PMID: 39137919 DOI: 10.1177/17085381241273281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES The modified Glasgow Prognostic Score (mGPS) is one type of inflammation-based index; it includes data on elevated C-reactive protein and reduced albumin content. The predictive value of mGPS for outcomes is investigated in various diseases such as cancer, heart failure, myocardial infarction, acute pulmonary embolism, and inflammatory bowel diseases. This study aimed to evaluate the link between mGPS and the severity and complexity of peripheral arterial disease (PAD) as determined by the Transatlantic Intercommunal Consensus Document (TASC-II) classification and the prediction value of mGPS for procedural success in patients undergoing endovascular treatment (EVT). METHODS Our study included 203 consecutive patients receiving EVT for atherosclerotic obstruction of aortoiliac, femoro-popliteal, and below-knee arteries between January 2019 and February 2020. The lesion characteristics were determined according to categories in the TASC-II. Operational failure is the inability to position the guidewire through the occluded lesion following percutaneous intervention or achieve distal perfusion following EVT. RESULTS In our study, we observed 136 patients (%6) with TASC A-B lesions and 67 patients (%33) with TASC C-D lesions. EVT was performed on the femoro-popliteal artery in 59.4% of the patients, on the aortoiliac artery in 30.7%, and on the below-the-knee artery in 9.9%. mGPS was an independent predictor of severe PAD (OR: 17.943, 95% CI: 5.120-62.882; p < .001) and procedural success (odds ratio: 0.004; 95% CI: 0.001-0.099; p < .001). Additionally, we identified age and the presence of a TASC D lesion as independent predictors of interventional success (OR: 0.938, 95% CI: 0.819-0.979; p: .034; OR: 0.104, 95% CI: 0.107-0.643; p: .015, respectively). CONCLUSION We determined that mGPS independently predicts PAD complexity and severity based on TASC-II classification; the EVT success rate is lower in patients with high mGPS.
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Affiliation(s)
- Ahmet Karaduman
- Department of Cardiology, Bitlis State Hospital, Bitlis, Turkey
| | - İsmail Balaban
- Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, University of Health Sciences, Istanbul, Turkey
| | - Kadir Biyiklı
- Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, University of Health Sciences, Istanbul, Turkey
| | | | - Semih Kalkan
- Department of Cardiology, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Kahyaoglu
- Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Celik
- Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, University of Health Sciences, Istanbul, Turkey
| | - Çetin Gecmen
- Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, University of Health Sciences, Istanbul, Turkey
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Meecham L, Popplewell M, Bate G, Davies HOB, Kodama A, Conte MS, Bradbury AW. Evaluation of the Global Limb Anatomic Staging System in patients with chronic limb-threatening ischemia undergoing endovascular intervention for femoropopliteal disease. J Vasc Surg 2023; 77:474-479.e3. [PMID: 36108823 DOI: 10.1016/j.jvs.2022.07.188] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/12/2022] [Accepted: 07/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Global Limb Anatomic Staging System (GLASS) is a new method of quantifying the anatomic severity of infrainguinal disease in patients with chronic limb-threatening ischemia. However, because GLASS has undergone limited validation, its value as an aid to shared decision-making regarding the choice of revascularization strategy remains incompletely defined. Here we report the relationship between GLASS and outcomes in a contemporary series comprising all 309 patients who underwent an attempt at femoropopliteal and/or infrapopiteal endovascular therapy for chronic limb-threatening ischemia in our unit between 2009 and 2014. METHODS Baseline patient characteristics and outcome data including immediate technical success (ITS), amputation-free survival (AFS), overall survival, limb salvage, freedom from reintervention (FF-R), and freedom from major adverse limb events (FF-MALE) were obtained from hospital databases. GLASS grades and stage were obtained from pre-endovascular therapy angiographic imaging. Outcome data were censored on May 31, 2017. RESULTS Baseline patient characteristics were similar across different GLASS femoropopliteal and IP grades and overall limb stages. Worsening GLASS stage was associated with a significant reduction in ITS (97.5% vs 91.5% vs 84.0%; P = .029). At 72 months FF-R (hazard ratio, 2.00; 95% confidence interval, 1.11-3.57; P = .020) and FF-MALE (hazard ratio, 1.76, 95% confidence interval, 1.10-2.81; P = .019) were significant worse in GLASS stage 3 than in stage 2 limbs. CONCLUSIONS In our study, there were significant differences in ITS, FF-R and FF-MALE between limbs with GLASS stage 2 and 3 disease. However, further GLASS refinement seems likely to be required if its usefulness in everyday clinical practice as an aid to shared decision-making regarding the choice of revascularization strategy is to be maximized.
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Affiliation(s)
- Lewis Meecham
- Department of Vascular Surgery, University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Mathew Popplewell
- Department of Vascular Surgery, University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gareth Bate
- Department of Vascular Surgery, University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Huw O B Davies
- Department of Vascular Surgery, University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michael S Conte
- Department of Surgery, University of California at San Francisco, San Francisco, CA
| | - Andrew W Bradbury
- Department of Vascular Surgery, University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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3
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Minici R, Ammendola M, Talarico M, Luposella M, Minici M, Ciranni S, Guzzardi G, Laganà D. Endovascular recanalization of chronic total occlusions of the native superficial femoral artery after failed femoropopliteal bypass in patients with critical limb ischemia. CVIR Endovasc 2021; 4:68. [PMID: 34491477 PMCID: PMC8423883 DOI: 10.1186/s42155-021-00256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Femoropopliteal bypass occlusions are a significant issue in patients with critical limb ischemia and chronic total occlusion of the native superficial femoral artery, which challenges vascular surgeons and interventional radiologists. Performing a secondary femoropopliteal bypass is still considered the standard of care, although it is associated with a higher complication rate and lower patency rate in comparison with primary bypass. Over the past few years, angioplasty has been commonly used, with the development in endovascular technologies, to treat chronic total occlusions of the native superficial femoral artery, with a good technical success rate and clinical prognosis. The purpose of the study is to assess the outcome of endovascular recanalization of chronic total occlusions of the native superficial femoral artery, in patients unfit for surgery with critical limb ischemia after failed femoropopliteal bypass. RESULTS A total of 54 patients were treated. 77.8 % of the conduits were PTFE grafts; the remainder were single-segment great saphenous veins. The most common clinical presentation was rest pain. Technical success was achieved in 51 (94.4 %) of 54 limbs. Angiographically, 77.8 % of the lesions were TASC II category D, while 22.2 % were TASC II category C. The average length of the native SFA lesions was 26.8 cm. Clinical success, with improved Rutherford classification staging, followed each case of technical success. The median follow-up value was 5.75 years (IQR, 1.5-7). By Kaplan-Meier survival analysis, primary patency rates were 61 % (± 0.07 SE) at 1 year and 46 % (± 0.07 SE) at 5 years. Secondary patency rates were 93 % (± 0.04 SE) at 1 year and 61 % (± 0.07 SE) at 5 years. Limb salvage rates were 94 % (± 0.03 SE) at 1 year and 88 % (± 0.05 SE) at 5 years. CONCLUSIONS The endovascular recanalization of chronic total occlusions (CTO) of the native superficial femoral artery (SFA) after a failed femoropopliteal bypass is a safe and effective therapeutic option in patients unfit for surgery with critical limb ischemia.
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Affiliation(s)
- Roberto Minici
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, Italy.
| | - Michele Ammendola
- Digestive Surgery Unit, Science of Health Department, Magna Graecia University, Catanzaro, Italy
| | - Marisa Talarico
- Cardiology Division, Giovanni Paolo II Hospital, Lamezia Terme, Italy
| | - Maria Luposella
- Cardiovascular Disease Unit, San Giovanni di Dio Hospital, Crotone, Italy
| | - Marco Minici
- Institute for high performance computing and networking (ICAR), National Research Council (Cnr), Rende, Italy
| | - Salvatore Ciranni
- Vascular Surgery Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Giuseppe Guzzardi
- Radiology Division, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
| | - Domenico Laganà
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, Italy
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Zielinski LP, Chowdhury MM, Coughlin PA. Patient and Institutional Costs of Failure of Angioplasty of the Superficial Femoral Artery. Ann Vasc Surg 2021; 72:218-226. [PMID: 32889162 DOI: 10.1016/j.avsg.2020.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Debate surrounds the optimal management of superficial femoral artery (SFA) disease. Randomized trial data rarely reflect real world findings, specifically the consequences to the patient of angioplasty failure. We observed the effect of a failed SFA angioplasty on the need for repeated clinic visits, hospital readmissions, imaging requirements, and reinterventions. METHODS We reviewed a consecutive series of 148 patients (94 men, median age 72 years) undergoing solely SFA angioplasty over a 2-year period. Patient preangioplasty demographics and 2-year post-PTA follow-up data were collated, including hospital attendances (inpatient/outpatient), further imaging (including radiation exposure) and revascularization attempts. We defined "failed angioplasty" as presence of clinical symptoms with radiological evidence of significant restenosis after an initial successful primary SFA angioplasty. RESULTS Fifty-four patients represented with a failed angioplasty (median time of 4 months after index PTA). In this group, failure of index angioplasty resulted in a further 185 restenosis-related clinic visits and a total of 537 bed days of inpatient stay. This group underwent a further 149 imaging events and required a further 34 endovascular revascularization procedures and 12 infrainguinal bypass procedures. These interventions and investigations corresponded to overall effective radiation dose across all patients of 190.69 mSv. Of the cohort of 99 patients who did not have a "failed angioplasty," they required 100 clinic visits, 21 further scans (total radiation dose 6.42 mSv), and 36 bed days of inpatient admission. CONCLUSIONS Failed angioplasty results in significant additional consequences for patients and health-care systems. Further work should focus on refining decision-making, providing the right procedure to the right patient at the right time.
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Affiliation(s)
- Lukasz Piotr Zielinski
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation trust, Cambridge, United Kingdom
| | - Mohammed M Chowdhury
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation trust, Cambridge, United Kingdom
| | - Patrick A Coughlin
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation trust, Cambridge, United Kingdom.
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Stahlberg E, Allmendinger AC, Anton S, Planert M, Jacob F, Barkhausen J, Goltz JP. Post-dilatation of an interwoven nitinol stent using a paclitaxel-coated balloon for revascularization of complex femoro-popliteal lesions. Cardiovasc Interv Ther 2020; 36:338-346. [PMID: 32803671 DOI: 10.1007/s12928-020-00697-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022]
Abstract
To evaluate technical success, safety and efficacy of post-dilatation of an interwoven nitinol stent using a paclitaxel-coated balloon (PCB) for revascularization of complex femoro-popliteal lesions. Thirty patients (26 male, mean age 70 ± 7 years) suffering from peripheral artery disease (PAD) (Rutherford category II-III) underwent revascularization of chronic total occlusions (n = 22, 73%) or severe stenosis (n = 8, 27%) of the femoro-popliteal segment. Mean lesion length was 251 ± 85 mm. Lesions were treated by pre-dilatation (POBA), implantation of a helical interwoven stent and post-dilatation with a PCB. Technical success was defined as residual stenosis < 30%. Follow-up included clinical visits, duplex ultrasound and ABI at 6 and 12 months. Endpoints were patency (re-stenosis < 50%), complications, improvement of Rutherford category and ABI. Regarding patency two sub-groups were compared: long-("LL"; < 25 cm, n = 12, mean 175 ± 38 mm) and ultra-long lesions ("ULL"; ≥ 25 cm, n = 13, mean 322 ± 43 mm). Technical success was 100%. In 1/30 patients (3.3%), a minor complication occurred (embolism). The overall primary and secondary patency rates at 12 months were 80.0% (95% CI 72.5-96.9%) and 92.0% (95% CI 84.7-100%). In the LL-sub-group, primary patency was 100%, and in the ULL-sub-group, primary patency was 61.5% (95% CI 51.8-92.3%) (p = 0.056), and secondary patency 84.6% (95% CI 71.3-100%), respectively. Rutherford category increased by at least one category in 92% of patients, ABI increased from 0.52 ± 0.13 (baseline) to 0.9 ± 0.14 (12 months) (p = 0.001). Five patients underwent target lesion revascularization during follow-up (bypass: n = 1, endovascular: n = 4). No death was observed during follow-up. Post-dilatation of an interwoven nitinol stent using a paclitaxel-coated-balloon proved to be safe and effective with promising outcomes in long- and ultra-long lesions up to 12 months of follow-up.
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Affiliation(s)
- Erik Stahlberg
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Ann Christin Allmendinger
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Susanne Anton
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Mathis Planert
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Fabian Jacob
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Jan Peter Goltz
- Institute for Diagnostic and Interventional Radiology/Neuroradiology, SANA Hospital, Lübeck, Germany
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Süleymanoğlu M, Burak C, Gümüşdağ A, Yesin M, Rencüzoğulları İ, Karabağ Y, Çağdaş M, Çap M. Assessment of the relation between C-reactive protein to albumin ratio and the severity and complexity of peripheral arterial disease. Vascular 2020; 28:731-738. [DOI: 10.1177/1708538120925952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Peripheral arterial disease is associated with increased cardiovascular mortality and morbidity. C-reactive protein and albumin are biomarkers of inflammation and malnutrition that play key roles in the pathophysiological pathways involved in the progression of atherosclerosis and peripheral arterial disease. In this study, we aimed to assess the relationship between C-reactive protein to albumin ratio and the suprapopliteal peripheral arterial disease severity and complexity as assessed by TransAtlantic Inter-Society Consensus-II (TASC-II) classification. Method Our study enrolled 224 consecutive patients referred for peripheral angiography with the clinical features of possible peripheral arterial disease at a tertiary care center between January 2016 and September 2019. Level of disease and lesion characteristics were defined with reference to angiographic findings according to the TASC-II classification. Results C-reactive protein/albumin ratio levels were significantly higher in TASC-II class C and D than in TASC-II class B patients with a median level of 1.8 to 2.1 vs 1.4, respectively ( p = 0.018). In multivariate regression analysis, C-reactive protein to albumin ratio remained an independent predictor of severe peripheral arterial disease. The predictive performance of C-reactive protein to albumin ratio, C-reactive protein, and albumin were compared by Receiver Operating Characteristic curve analysis. C-reactive protein to albumin ratio surpassed C-reactive protein and albumin in predicting peripheral arterial disease severity and complexity. A level of C-reactive protein to albumin ratio > 0.14 predicted a higher grade of suprapopliteal TASC-II class with sensitivity and specificity of 68.2% and 56.0%, respectively. Conclusion C-reactive protein to albumin ratio was strongly associated with peripheral arterial disease severity and complexity, as assessed by TASC-II classification. Also, C-reactive protein to albumin ratio was found to be a more accurate marker than C-reactive protein and albumin alone in predicting more severe and complex lesions in patients with peripheral arterial disease.
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Affiliation(s)
| | - Cengiz Burak
- Department of Cardiology, M.D. Kafkas University Medical Faculty, Kars, Turkey
| | - Ayça Gümüşdağ
- Department of Cardiology, M.D. Kafkas University Medical Faculty, Kars, Turkey
| | - Mahmut Yesin
- Department of Cardiology, M.D. Kafkas University Medical Faculty, Kars, Turkey
| | | | - Yavuz Karabağ
- Department of Cardiology, M.D. Kafkas University Medical Faculty, Kars, Turkey
| | - Metin Çağdaş
- Department of Cardiology, M.D. Kafkas University Medical Faculty, Kars, Turkey
| | - Murat Çap
- Department of Cardiology, M.D. University of Health Sciences, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
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