open access

Vol 77, No 1 (2019)
Original articles
Published online: 2018-10-08
Submitted: 2018-07-28
Accepted: 2018-10-05
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Dynamics of below-the-knee arterial blood flow after endovascular revascularisation of peripheral arteries as a potential predictor of clinical outcomes during one-year follow-up

Paweł Kaczmarczyk, Marek Krzanowski, Ewelina Szybiak, Mikołaj Maga, Agnieszka Wachsmann, Katarzyna Tyrak, Rafał Januszek, Andrzej Belowski, Łukasz Partyka, Paweł Maga
DOI: 10.5603/KP.a2018.0212
·
Pubmed: 30338500
·
Kardiol Pol 2019;77(1):24-32.

open access

Vol 77, No 1 (2019)
Original articles
Published online: 2018-10-08
Submitted: 2018-07-28
Accepted: 2018-10-05

Abstract

Background: Patients with advanced lower limb ischaemia are, at present, mainly treated using revascularisation.

Aim: The aim of the study was to investigate whether the dynamics of blood flow in below-the-knee (BTK) arteries assessed by angiography correlate with clinical outcomes after a 12-month follow-up in patients with severe leg ischaemia treated per­cutaneously.

Methods: The current study enrolled 287 consecutive patients who underwent 302 endovascular procedures on the infrain­guinal arteries. The mean age of the included participants was 67.4 ± 10.4 years. After the procedure, blood flow in all patent BTK arteries was assessed using frame count (FC). Patients were then evaluated after one, three, six, and 12 months. During the follow-up visits, clinical condition was evaluated based on the Rutherford scale, ankle-brachial index, and the need for reintervention or amputation.

Results: Clinical improvement at the end of the follow-up period was observed in 242 (80.1%) cases and no improvement or worsening in was seen in 42 (13.0%) patients. In total, 66 (21.8%) reinterventions and 18 (6%) amputations during the follow-up period were recorded. Patients with higher FC in the tibial anterior artery experienced significantly better clinical improvement within the 12-month follow-up period (p = 0.02). Lower FC predisposed to worse clinical outcomes after an­gioplasty. Similar tendencies were found for the tibial posterior and fibular arteries but without statistical significance.

Conclusions: The results suggest a negative relationship between FC observed on the final angiogram and clinical outcomes in patients undergoing endovascular treatment of the peripheral arteries.

Abstract

Background: Patients with advanced lower limb ischaemia are, at present, mainly treated using revascularisation.

Aim: The aim of the study was to investigate whether the dynamics of blood flow in below-the-knee (BTK) arteries assessed by angiography correlate with clinical outcomes after a 12-month follow-up in patients with severe leg ischaemia treated per­cutaneously.

Methods: The current study enrolled 287 consecutive patients who underwent 302 endovascular procedures on the infrain­guinal arteries. The mean age of the included participants was 67.4 ± 10.4 years. After the procedure, blood flow in all patent BTK arteries was assessed using frame count (FC). Patients were then evaluated after one, three, six, and 12 months. During the follow-up visits, clinical condition was evaluated based on the Rutherford scale, ankle-brachial index, and the need for reintervention or amputation.

Results: Clinical improvement at the end of the follow-up period was observed in 242 (80.1%) cases and no improvement or worsening in was seen in 42 (13.0%) patients. In total, 66 (21.8%) reinterventions and 18 (6%) amputations during the follow-up period were recorded. Patients with higher FC in the tibial anterior artery experienced significantly better clinical improvement within the 12-month follow-up period (p = 0.02). Lower FC predisposed to worse clinical outcomes after an­gioplasty. Similar tendencies were found for the tibial posterior and fibular arteries but without statistical significance.

Conclusions: The results suggest a negative relationship between FC observed on the final angiogram and clinical outcomes in patients undergoing endovascular treatment of the peripheral arteries.

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Keywords

clinical endpoints, endovascular treatment, frame count, peripheral arterial disease, predictors

About this article
Title

Dynamics of below-the-knee arterial blood flow after endovascular revascularisation of peripheral arteries as a potential predictor of clinical outcomes during one-year follow-up

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 77, No 1 (2019)

Pages

24-32

Published online

2018-10-08

DOI

10.5603/KP.a2018.0212

Pubmed

30338500

Bibliographic record

Kardiol Pol 2019;77(1):24-32.

Keywords

clinical endpoints
endovascular treatment
frame count
peripheral arterial disease
predictors

Authors

Paweł Kaczmarczyk
Marek Krzanowski
Ewelina Szybiak
Mikołaj Maga
Agnieszka Wachsmann
Katarzyna Tyrak
Rafał Januszek
Andrzej Belowski
Łukasz Partyka
Paweł Maga

References (24)
  1. Setacci C, de Donato G, Teraa M, et al. Chapter IV: Treatment of critical limb ischaemia. Eur J Vasc Endovasc Surg. 2011; 42 Suppl 2: S43–S59.
  2. Moxey PW, Brownrigg J, Kumar SS, et al. The BASIL survival prediction model in patients with peripheral arterial disease undergoing revascularization in a university hospital setting and comparison with the FINNVASC and modified PREVENT scores. J Vasc Surg. 2013; 57(1): 1–7.
  3. Arvela E, Söderström M, Korhonen M, et al. Finnvasc score and modified Prevent III score predict long-term outcome after infrainguinal surgical and endovascular revascularization for critical limb ischemia. J Vasc Surg. 2010; 52(5): 1218–1225.
  4. Maga P, Sanak M, Jawien J, et al. 11-dehydro thromboxane B2 levels after percutaneous transluminal angioplasty in patients with peripheral arterial occlusive disease during a one year follow-up period. J Physiol Pharmacol. 2016; 67(3): 377–383.
  5. Davies AH, Magee TR, Parry R, et al. Evaluation of distal run-off before femorodistal bypass. Cardiovasc Surg. 1996; 4(2): 161–164.
  6. Hiramori S, Soga Y, Tomoi Y, et al. Impact of runoff grade after endovascular therapy for femoropopliteal lesions. J Vasc Surg. 2014; 59(3): 720–727.
  7. Davies MG, Saad WE, Peden EK, et al. Impact of runoff on superficial femoral artery endoluminal interventions for rest pain and tissue loss. J Vasc Surg. 2008; 48(3): 619–25; discussion 625.
  8. Perez de Prado A, Fernández-Vázquez F, Cuellas-Ramón JC, et al. Coronary clearance frame count: a new index of microvascular perfusion. J Thromb Thrombolysis. 2005; 19(2): 97–100.
  9. Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996; 93(5): 879–888.
  10. Reiner Z, Catapano AL, De Backer G, et al. European Association for Cardiovascular Prevention & Rehabilitation, ESC Committee for Practice Guidelines (CPG) 2008-2010 and 2010-2012 Committees. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J. 2011; 32(14): 1769–1818.
  11. Ponikowski P, Voors AA, Anker SD, et al. Authors/Task Force Members, Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016; 18(8): 891–975.
  12. Rydén L, Grant PJ, Anker SD, et al. Authors/Task Force Members, ESC Committee for Practice Guidelines (CPG), Document Reviewers. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013; 34(39): 3035–3087.
  13. Williams B, Mancia G, Spiering W, et al. ESC Scientific Document Group . 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021–3104.
  14. Montalescot G, Sechtem U, Achenbach S, et al. Task Force Members, ESC Committee for Practice Guidelines, Document Reviewers. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013; 34(38): 2949–3003.
  15. Siracuse JJ, Giles KA, Pomposelli FB, et al. Results for primary bypass versus primary angioplasty/stent for intermittent claudication due to superficial femoral artery occlusive disease. J Vasc Surg. 2012; 55(4): 1001–1007.
  16. Soga Y, Iida O, Hirano K, et al. Mid-term clinical outcome and predictors of vessel patency after femoropopliteal stenting with self-expandable nitinol stent. J Vasc Surg. 2010; 52(3): 608–615.
  17. Sobkowicz B, Tomaszuk-Kazberuk A, Kralisz P, et al. Coronary blood flow in patients with end-stage renal disease assessed by thrombolysis in myocardial infarction frame count method. Nephrol Dial Transplant. 2010; 25(3): 926–930.
  18. Ihnat DM, Duong ST, Taylor ZC, et al. Contemporary outcomes after superficial femoral artery angioplasty and stenting: the influence of TASC classification and runoff score. J Vasc Surg. 2008; 47(5): 967–974.
  19. Davies MG, Saad WE, Peden EK, et al. Percutaneous superficial femoral artery interventions for claudication--does runoff matter? Ann Vasc Surg. 2008; 22(6): 790–798.
  20. Wu TY, Giesler G, Herscu G, et al. Agreement among observers in the assignment of TransAtlantic Inter-Society Consensus classification and runoff score. J Vasc Surg. 2013; 58(5): 1254–1258.
  21. Akasaka T, Yoshida K, Kawamoto T, et al. Relation of phasic coronary flow velocity characteristics with TIMI perfusion grade and myocardial recovery after primary percutaneous transluminal coronary angioplasty and rescue stenting. Circulation. 2000; 101(20): 2361–2367.
  22. Kim AH, Shevitz AJ, Morrow KL, et al. Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography. J Vasc Surg. 2017; 66(5): 1464–1472.
  23. Salapura V, Blinc A, Kozak M, et al. Infrapopliteal run-off and the outcome of femoropopliteal percutaneous transluminal angioplasty. Vasa. 2010; 39(2): 159–168.
  24. Prince MR, Chabra SG, Watts R, et al. Contrast material travel times in patients undergoing peripheral MR angiography. Radiology. 2002; 224(1): 55–61.

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