Endovascular Revascularization In Patients Research Articles

Predictors of Survival Without Intestinal Resection after First-Line Endovascular Revascularization in Patients with Acute Arterial Mesenteric Ischemia.

Background Acute arterial mesenteric ischemia requires emergency treatment and is associated with high mortality rate and poor quality of life. Identifying factors associated with survival without intestinal resection (hereafter, intestinal resection-free [IRF] survival) could help in treatment decision-making after first-line endovascular revascularization. Purpose To identify factors associated with 30-day IRF survival in patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization. Materials and Methods Patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization because of a low probability of bowel necrosis were included in this single-center retrospective cohort (May 2014 to August 2022). Patient demographics, laboratory values, clinical characteristics at admission, CT scans, angiograms, and endovascular revascularization-related variables were included. The primary end point was 30-day IRF survival, and secondary end points were 3-month, 1-year, and 3-year overall survival. Factors independently associated with 30-day IRF survival were identified with binary logistic regression. Results A total of 117 patients (median age, 70 years [IQR, 60-77]; 53 female, 64 male) were included. Within 30 days after revascularization, 73 of 117 patients (62%) survived without resection, 28 of 117 (24%) survived after resection, 14 of 117 (12%) died without resection, and two of 117 (2%) underwent resection but died. The 30-day IRF survival was 63% (74 of 117). The 3-month, 1-year, and 3-year mortality rate was 18% (21 of 117), 21% (25 of 117), and 27% (32 of 117), respectively. Independent predictors of 30-day IRF survival were persistent bowel enhancement at initial CT (odds ratio [OR], 0.3; 95% CI: 0.2, 0.8; P = .013) and C-reactive protein (CRP) level less than 100 mg/L (OR, 0.3; 95% CI: 0.1, 0.8; P = .002). The 30-day IRF survival was 86%, 61%, 47%, and 23% in patients with both favorable features, persistent bowel enhancement but CRP level greater than 100 mg/L, no bowel enhancement but CRP level less than 100 mg/L, and both unfavorable features, respectively. Conclusion Independent predictors associated with 30-day IRF survival in patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization were persistent bowel wall enhancement at initial CT and CRP level less than 100 mg/L. © RSNA, 2024 Supplemental material is available for this article.

Risk Factors for Major Lower Limb Amputation and Effect of Endovascular Revascularization in Patients with Diabetic Foot Wound.

Major lower extremity amputation (LEA) such as below-knee or above-knee amputations can result in more physical disabilities and poorer socioeconomic functions than minor LEAs in diabetic foot ulcer (DFU). Therefore, identification of risk factors for major LEA and investigation of effectiveness of endovascular revascularization are critical for prevention and better prognosis of DFU patients. From January 2014 to December 2017, a total of 125 patients with DFU treated with any level of amputation were included in this study. Demographic, diabetes-related, DFU-related and -relevant laboratory information were investigated to predict major amputation. To identify risk factors for major amputation, logistic regression analysis was performed for each variable. The effectiveness of endovascular revascularization treatment was analyzed using Kaplan-Meier survival curves. Major amputation was performed for 22 of 125 patients. Multivariate logistic regression analysis indicated that DM duration, peripheral arterial occlusive disease (PAOD) previous amputation, abscess, Wagner grade, CRP and albumin were significant risk factors for major amputation in DFU patients. PAOD was the most important risk factor. Major amputation-free survival rate at 5years was 97.4% in a non-PAOD group, 58.3% in a PAOD without revascularization group, and 88.0% in a PAOD with revascularization group, showing statistically significant differences among them. The duration of DM, PAOD, previous amputation, abscess, Wagner grade, CRP and albumin were major risk factors for major LEA in DFU patients. The most valuable and critical finding was that revascularization in diabetic foot patients with PAOD significantly improved major amputation-free survival rates.

The influence of sex disparities on outcomes after infrainguinal endovascular revascularization in patients with symptomatic peripheral arterial disease

The influence of sex disparities on outcomes after infrainguinal endovascular revascularization in patients with symptomatic peripheral arterial disease

What have we learned from two trials comparing open surgery and endovascular revascularization in patients with chronic limb threatening ischemia?

What have we learned from two trials comparing open surgery and endovascular revascularization in patients with chronic limb threatening ischemia?

Use of intravascular lithotripsy in non-coronary artery lesions.

Intravascular lithotripsy (IVL) is a novel technique increasingly used for plaque modification and endovascular revascularization in patients with severe calcification and peripheral artery disease. However, much of the available literature on IVL is focused on its use in coronary arteries, with relatively limited data on non-coronary artery use. To analyze the safety and efficacy of current IVL use in non-coronary artery lesions, as reported in case reports and case series. We searched EMBASE, PubMed, and Reference Citation Analysis databases for case reports and case series on IVL use in peripheral artery disease. We then extracted variables of interest and calculated the mean and proportions of these variables. We included 60 patients from 33 case reports/case series. Ninety-eight percent of the cases had IVL usage in only one blood vessel, while four had the IVL used in two vessels (2.0%), resulting in 64 Lesions treated with IVL. The mean age of the patients was 73.7 (SD 10.9). IVL was successfully used in severe iliofemoral artery stenosis (51.6%), severe innominate, subclavian, and carotid artery stenosis (26.7% combined), and severe mesenteric vessel stenosis (9.4%). Additionally, IVL was successfully used in severe renal (7.8%) and aortic artery (4.7%) stenosis. There were complications in 12% of the cases, with dissection being the commonest. IVL has successfully used in plaque modification and endovascular revascularization in severely calcified and challenging lesions in the iliofemoral, carotid, subclavian, aorta, renal, and mesenteric vessels. The most severe but transient complications were with IVL use in the aortic arch and neck arteries.

Renal perfusion improvement in the perioperative period after unilateral endovascular revascularization in patients with atherosclerotic renal artery stenosis.

The clinical benefits of endovascular treatment in renal artery stenosis (RAS) remain controversial. This study used an intraoperative renal perfusion imaging technique, called flat-panel detector parenchymal blood volume imaging (FD-PBV), to observe the change in renal perfusion after endovascular treatment in RAS. In a prospective, single-center study, we assigned 30 patients with atherosclerotic RAS who underwent endovascular treatment between March 2016 and March 2021. The preoperative and postoperative results of renal perfusion, blood pressure, and renal function, were compared. Both median kidney volume (p < 0.001) and median preoperative mean density of contrast medium (MDCM) (p = 0.028) increased significantly after endovascular treatment. The ratio of postoperative and preoperative MDCM differed greatly among the patients. For patients with preoperative MDCM <304.0 HU (Subgroup A, 15 cases), MDCM significantly increased after treatment (p = 0.001) and 12 (80.0%) patients had more than 10% increase in renal perfusion. For patients who had relatively high preoperative renal perfusion (MDCM ≥304.0 HU, Subgroup B, 15 cases), preoperative and postoperative MDCM were similar (p = 0.776). On the other hand, the serum creatinine levels significantly decreased in Subgroup A (p = 0.033) and fewer antihypertensive drugs were used after endovascular revascularization (p = 0.041). The preoperative and postoperative creatinine levels and number of antihypertensive drugs were similar in Subgroup B. During the perioperative period, RAS patients with relatively low preoperative renal perfusion levels had greater improvement in renal perfusion, renal function, and blood pressure control after endovascular treatment. The improvement of renal function needs to be confirmed by long-term follow-up.

A Novel Score Predicts Need of Open Revascularization Following Endovascular Revascularization in Patients with Infrainguinal Chronic Limb-threatening Ischemia

This study aims to assess the ability of a novel score, the infrainguinal successful endovascular treatment (iSET) score in predicting risk of open revascularization in patients undergoing endovascular revascularization (ER) for infrainguinal chronic limb-threatening ischemia (CLTI). A retrospective analysis of consecutive patients undergoing ER for CLTI between January 2015 and December 2018. The iSET is a score between 1 and 63. It combines components of the Global Vascular Guidelines evidence-based revascularization as follows: iSET = Wound, Ischemia, foot Infection (WIfI) × WIFI + inflow disease + 4 × Global limb anatomic staging system (GLASS) FP + 6 × GLASS IP + 3 × IM pedal modifier. It stratifies patients into low (0-21), moderate (22-42), and high (43-63). The primary outcome was freedom from open revascularization at 2 years. Secondary outcomes were 30-day and 1-year endovascular reintervention, major amputations (above the ankle joint), minor amputations (below the ankle joint) and mortality. Kaplan-Meier estimates and Cox proportional hazard model assessed ability of iSET to predict open revascularization risk. A P value < .05 was significant. The study included 159 limbs in 150 patients with 12% (n = 19), 53% (n = 84), and 35% (n = 56) having a low, moderate, and high iSET scores, respectively. Most patients presented with tissue loss (86%), WIfI stage 4 (64%), and GLASS III (47%). Patients with a high iSET were more likely to have received antibiotics prior to ER (odds ratio, 1.35; 95% confidence interval [CI], 1.08-1.70; P = .013) and less likely to have elective ER (odds ratio, 0.36; 95% CI, 0.18-0.72; P = .003). Most ER involved the femoropopliteal segment (84%), with 55% of these including concomitant infrapopliteal revascularization. Kaplan-Meier survival curves showed that 2-year freedom from open revascularization was 100%, 93%, and 79% with low, moderate, and high iSET, respectively (Fig). Mortality, reinterventions, and major amputations were similar at 30 days and 1 year (Table). There was an increase in minor amputations at 1 year with high iSET patients (38%; n = 20) compared with low (6%; n = 1) and moderate (21%; n = 15) iSET (P = .016). High iSET score predicted increased risk of open revascularization (hazard ratio, 4.75; 95% CI, 1.67-13.48; P = .003). The iSET is a novel comprehensive score incorporating guideline-driven parameters. The score correlated significantly with ER failure at 2 years with progressively lower freedom from open revascularization between low, moderate, and high iSET scores. Additionally, a high iSET score independently predicted subsequent open revascularization after ER. Further studies are needed to validate it as an adjunctive decision-making tool in patients with CLTI.TableThirty-day and 1-year outcomes in patients stratified by groupsOverallLowModerateHighP-value30-day Death2 (3)03 (2)2 (1).775 Endovascular reintervention8 (11)08 (6)10 (5).447 Major amputation2 (2)02 (1)3 (1).848 Minor amputation13 (18)6 (1)8 (6)21 (11).0861-year Death11 (15)013 (9)11 (6).334 Endovascular reintervention34 (48)31 (5)33 (24)37 (19).885 Major amputation13 (18)014 (10)15 (8).262 Minor amputation25 (36)6 (1)21 (15)38 (20).016Data is presented as percentage (number). Open table in a new tab

Extravascular Ultrasound (EVUS) to Assess the Results of Peripheral Endovascular Procedures

Contrast arteriography (CA) is considered the gold standard to evaluate any phase in peripheral arterial disease (PAD) interventions, from diagnostics to final results. Nevertheless, duplex ultrasonography (DUS) mostly used for the pre/postoperative phase and follow-up control, could be a potential intraoperative adjunctive imaging tool to assess the effects of endovascular revascularization in patients with iliac and femoropopliteal lesions. The PAD "duplex-assisted" protocol includes a preoperative DUS control followed by an intraoperative and a postoperative control. The most important parameters are pulsed doppler spectral analysis and waveform changes, which are impossible to detect with intravascular ultrasound (IVUS). By using a similar acronym, the intraoperative DUS has been previously described as extravascular ultrasound (EVUS). B-mode imaging, color flow, and peak systolic velocity (PSV) are considered. EVUS could be very useful to evaluate the effects of endovascular treatment, mainly in cases of unclear CAs, severe calcifications and/or dissections. In the context of the "leaving nothing behind" strategy, EVUS can drive the physician to evaluate the absence of flow-limiting dissections and decide which target lesion should be treated with antirestenotic therapy, further vessel preparation, or stenting. The EVUS protocol could be a safe and feasible option to improve the completion assessment of endovascular PAD treatment. A better ultrasound waveform is a sign of improved luminal gain and compliance, which is extremely important to finalize the results of new peripheral device technology, such as intravascular lithotripsy.

Use of stents with medication coating for the treatment of occlusive-stenotic lesions of the superficial femoral artery

Objective ‒ to analyze the results of endovascular revascularization of the femoropopliteal segment with drug-eluting stents. Materials and methods. Endovascular intervention was performed in 23 patients with stenotic lesions of the superficial femoral artery (SFA). Paclitaxel-eluting stents were used. There were 10 men (43.5 %), 13 women (56.5 %). The mean age of the patients was (66.0 ± 3.5) years. There were 16 (69.6 %) patients with diabetes mellitus type 2 and diabetic angiopathy, and 7 (23.4 %) patients had obliterating atherosclerosis of the arteries of the lower limbs. Critical ischemia of the lower extremities was diagnosed in 18 (56.5 %) cases, intermittent claudication ‒ in 5 (21.7 %). Isolated lesions of the femoral-popliteal segment were noted in 3 (13.4 %) patients, lesions of the iliac and femoral-popliteal segments ‒ in 4 (17.4 %), lesions of the femoral-popliteal and ankle segments ‒ in 16 (69.6 %). Results. Twenty (86.6 %) scheduled procedures for stenting of the SFA were technically successful. Among postoperative complications, 3 (13.04 %) patients had puncture site hematomas that did not require surgical evacuation. In 6 (26.1 %) patients, signs of reperfusion syndrome were observed, which were treated with conservative treatment. During follow-up period (3 months), there were no cases of reocclusion or clinically significant restenosis at the stented level. In 1 (5.0 %) case, a hemodynamically significant stenosis of the SFA was observed outside the implanted stent. The patient successfully underwent angioplasty of SFA stenosis. There were no «major» amputations during follow-up period. «Small» ankle amputations were performed in 7 (35.0 %) patients with diabetic gangrene, where endovascular revascularization of the femoro-popliteal and ankle segments was the stage of surgical treatment. Conclusions. Implantation of drug-eluting stents is an effective method of endovascular revascularization in patients with SFA lesions. To compare the results of implantation of drug-eluting stents with other methods of revascularization of the lesions of the femoro-popliteal segment, it is necessary to accumulate more data and increase the duration of the follow-up period.

DRUG-ELUTING STENTS IN THE TREATMENT OF PATIENTS WITH OCCLUSIVE-STENOTIC LESIONS OF THE SUPERFICIAL FEMORAL ARTER.

The aim: To analyze the results of endovascular revascularization of the femoropopliteal segment using drug-eluting stents. Materials and methods: Endovascular intervention was performed in 23 patients with occlusive-stenotic lesions of the superficial femoral artery (SFA). Paclitaxel-eluting stents were used. There were 16 (69.6%) patients with diabetes mellitus type 2 and diabetic angiopathy, and 7 (30.4%) patients had obliterating atherosclerosis of the arteries of the lower limbs. Critical ischemia of the lower extremities was diagnosed in 18 (78.3%) cases, and intermittent claudication - in 5 (21.7%). Results: Twenty (86.6 %) scheduled procedures for stenting of the SFA were technically successful. During follow-up period (3 months), there were no cases of reocclusion or clinically significant restenosis at the stented level. There were no "major" amputations during follow -up period. "Small" ankle amputations were performed in 7 (35%) patients with diabetic gangrene. Conclusions: Implantation of drug-eluting stents is an effective method of endovascular revascularization in patients with SFA lesions. To compare the results of implantation of drug-eluting stents with other methods of revascularization of the lesions of the femoro-popliteal segment, it is necessary to accumulate more data and increase the duration of the follow-up period.

Optimal strategy for antiplatelet therapy after endovascular revascularization in patients with lower extremity artery disease

Abstract Background The duration of antiplatelet therapy after endovascular revascularization in patients with lower extremity artery disease (LEAD) has not been well established. This study aimed to evaluate the clinical outcome according to the duration of dual antiplatelet therapy (DAPT) in real practice. Methods From April 2009 to June 2019, 376 patients with LEAD underwent successful endovascular revascularization. After the procedure, the received single antiplatelet therapy (SAPT) or DAPT of various durations were classified into two groups (SAPT or DAPT &amp;lt;6 months vs. DAPT ≥6 months). The primary outcomes were major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs). The safety outcome was moderate-to-severe bleeding according to the Global Use of Strategies to Open Occluded Arteries (GUSTO) criteria. Results Over the 40-month follow-up period, MACE occurred less frequently in the DAPT ≥6 months group than that in the SAPT or DAPT &amp;lt;6 months group (12.4% vs. 23.8%; hazard ratio [HR]: 0.56; 95% confidence interval [CI]: 0.35–0.89; p=0.014) after inverse probability-weighted adjustment and propensity-score matching analysis (HR: 0.55, 95% CI; 0.30–0.99, p=0.048). The incidence of MALE did not show significant difference between the two groups (DAPT ≥6 months group: 17.1% vs. SAPT or DAPT &amp;lt;6 months group: 13.1%; HR: 1.05; 95% CI: 0.62–1.78; p=0.846). A significant difference between the DAPT ≥6 months group and the SAPT or DAPT &amp;lt;6 months group was not observed regarding the incidence of moderate-to-severe GUSTO bleeding. Conclusions In patients with LEAD, DAPT for ≥6 months after endovascular revascularization was associated with a lower incidence of MACE. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Research Foundation of Korea (NRF) grant funded by the government of Korea (MSIT) (No. 2019R1G1A1100442).

TCT-219 Optimal Strategy for Antiplatelet Therapy After Endovascular Revascularization in Patients With Lower Extremity Artery Disease

TCT-219 Optimal Strategy for Antiplatelet Therapy After Endovascular Revascularization in Patients With Lower Extremity Artery Disease

Major Adverse Events in Patients with Peripheral Artery Disease after Endovascular Revascularization: A Retrospective Study.

Objective: For peripheral artery disease (PAD) patients, after endovascular revascularization, it is crucial to manage associated factors that can affect the risk of major adverse events. We aimed to investigate the associated factors of major adverse events in these patients. Materials and Methods: We conducted a retrospective longitudinal analysis using the electronic medical records from a tertiary hospital in Korea and included the data of 1263 patients. Eligible patients were categorized into four groups based on diabetes mellitus (DM) and regular exercise. The major adverse events included major adverse limb events and major adverse cardiovascular events. Major adverse events-free survival was assessed using the Kaplan–Meier method, and associated factors of major adverse events were analyzed using Cox proportional hazards analyses. Results: Kaplan–Meier survival curves showed that patients with DM and non-regular exercise had a shorter major adverse events-free survival. The Cox regression analysis showed that for patients with critical limb ischemia or chronic kidney disease, the risk of major adverse events increased, while group variables were not significant. Conclusion: Target management of patients with DM, critical limb ischemia, and chronic kidney disease is essential to reduce major adverse events after endovascular revascularization in patients with PAD.

Factors Affecting Mortality of Critical Limb Ischemia 1 Year after Endovascular Revascularization in Patients with Type 2 Diabetes Mellitus.

BACKGROUNDChronic limb ischemia (CLI) is strongly associated with increased mortality in diabetes patients.OBJECTIVEThe aim of this study was to evaluate factors affecting mortality within 1 year after endovascular revascularization in CLI patients.METHODSThis retrospective cohort study was based on medical records from the Integrated Cardiovascular Centre of Dr. Cipto Mangunkusumo National General Hospital, a tertiary care hospital in Jakarta, Indonesia. The study included 199 CLI patients with type 2 diabetes mellitus (T2DM) who underwent endovascular revascularization from January 2008 to June 2018. The patients were followed up for 1 year after endovascular revascularization. Kaplan-Meier and Cox proportional hazard analysis was used to analyze the data.RESULTS1-year survival probability was 58.8%. Cox proportional hazard analysis showed that duration of diabetes (HR 3.52; 95% CI 1.34-9.22), anemia (HR 2.59; 95% CI 1.47-4.56), and smoking (HR 2.49; 95% CI 1.46-4.27) were significantly associated with mortality within 1 year after endovascular revascularization.CONCLUSIONSIn T2DM patients with CLI, duration of diabetes, anemia and smoking were associated with a higher risk of mortality within 1 year post endovascular revascularization

The periprocedural and 30-day outcomes of carotid stenting in patients with carotid artery near-occlusion

The safety of endovascular revascularization in patients with carotid artery near occlusion (CANO) is unknown. We aimed to evaluate the peri-procedural risk in CANO patients receiving carotid artery stenting (CAS). A prospective data base with retrospective review was performed to identify patients who underwent CAS with CANO from July 2006 to July 2020, and had at least 1-month clinical follow-up data. The primary endpoints were stroke, hyperperfusion syndrome, and death within 30 days after CAS. A total of 198 patients with carotid artery stenosis were enrolled including 92 patients with CANO and 106 age and sex-matched patients with 70–99% conventional carotid stenosis. Full distal carotid collapse was found in 45 CANO patients (45/92, 49%). The technical success rate was 100%. The CANO patients had significantly longer lesion lengths compared with those of the non-CANO group. The incidence of hyperperfusion syndrome was comparable (CANO: 2.2%, non-CANO: 0.9%, P = 0.598). The risks of ischemic stroke and death within 30 days were 1.1% and 0% in the CANO group; and 1.9% and 0.9%, in the non-CANO group, respectively, without statistical difference. In conclusion, CAS is safe for patients with CANO, with a similar low 30-day peri-procedural event rate comparable to those of non-CANO.

Efficiency of endovascular revascularization in patients with chronic heart failure with reduced left ventricular ejection fraction and diabetes mellitus according to a five-year observation

Abstract Purpose The purpose of the study was to evaluate the effect of endovascular coronary revascularization in patients with coronary heart disease (CHD) complicated by chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) and comorbid with type 2 diabetes mellitus (DM) according to a five-year prospective follow-up. Material and methods The study included a total of 83 patients with coronary artery disease with CHF functional class (FC) II-III according to NYHA and LVEF less than 40% aged 48 to 58 years. Group 1 (n=38) included patients with CHD without DM; group 2 comprised 45 patients with CHD associated with DM. The endpoint was one of the adverse cardiovascular events (CVE) (death, nonfatal myocardial infarction, acute coronary syndrome, stroke, stent restenosis, CHF progression by 1 FC or more, repeated coronary revascularization (surgical, endovascular), development of ventricular arrhythmia, atrial fibrillation, and implantation of a pacemaker) occurring within five years of observation. Results One year after endovascular intervention, LVEF increased by 10.3% (p=0.05) in group 1 and by 13.4% (p=0.05) in group 2. The LVEF values in DM patients decreased by 9.5% after three years of observation. Manifestation of CHF occurred by 4.6 and 3.7 times less frequently in patients of group 1 after one and three years, respectively, compared with that in DM patients. After five years, 15.4% of patients in group 2 and none in group 1 (p=0.006) required hospitalizations for CHF progression. After three years, repeated interventions were required twice more often in group 2 (p=0.041). After five years, no repeated interventions were performed in group 1 whereas 30.8% of patients in group 2 received repeated interventions (p=0.011). One year after coronary artery stenting, the Kaplan-Meier survival rates were 91.3% in group 1 and 93.3% in group 2. The study showed that the survival curves significantly (p=0.020) diverged after three years of observation and by the end of the fifth year (p=0.011). The study showed that smoking (odds ratio (OR) 3.861, p=0.01) and the level of postprandial glycemia (OR 2.622; p=0.01) were predictors for the development of unfavorable factors. Evaluation of DM course showed that patients with episodes of hypoglycemia were significantly more frequently diagnosed with onset of new unfavorable CVE including progression of atherosclerosis in the native coronary arteries (p=0.05) and, later, CHF decompensation (p=0.004–0.04). Findings The annual results were comparable between study groups. Assessment of results from three-year follow-up showed that patients with DM and CHF who underwent endovascular revascularization had a significantly lower survival rate and a higher need for repeated revascularization. The five-year survival rate was significantly lower in group of DM patients (p=0.011). Funding Acknowledgement Type of funding sources: None.

Supervised exercise therapy versus endovascular revascularization in patients with intermittent claudication.

Supervised exercise therapy versus endovascular revascularization in patients with intermittent claudication.

Limb-Based Patency After Surgical vs Endovascular Revascularization in Patients with Chronic Limb-Threatening Ischemia

Purpose: To determine whether limb-based patency (LBP) after infrainguinal revascularization for chronic limb-threatening ischemia (CLTI) is similar between bypass surgery and endovascular therapy (EVT). Materials and Methods: The database for the Surgical Reconstruction vs Peripheral Intervention in Patients With Critical Limb Ischemia (SPINACH) study was interrogated to identify 130 patients (mean age 73±8 years; 94 men) who underwent bypass surgery and 271 patients (mean age 74±10 years; 178 men) who underwent EVT alone. Skin perfusion pressure (SPP) and the ankle-brachial index (ABI) were measured before the procedure and at 0, 1, and 3 months after revascularization. The outcome measure was hemodynamically evaluated LBP (SPP ≥10 mm Hg or ABI ≥0.1) maintained over the first 3 months after treatment. Any reintervention or major amputation was regarded as loss of LBP. The associations between the revascularization strategy (bypass vs EVT) and between the preoperative characteristics and the study outcome (ie, SPP- or ABI-based LBP), were determined using generalized linear mixed models with a logit link function. Patency rates are presented with the 95% confidence interval (CI). Results: The bypass surgery group had a higher stage of limb severity (WIfI) and anatomic complexity (GLASS) than the EVT group, whereas the EVT group had a higher prevalence of heart failure. Both SPP- and ABI-based LBP rates were higher in the bypass group than in the EVT group. SPP-based LBP rates at 3 months were 73.8% (95% CI 63.4% to 84.2%) in the bypass group and 46.2% (95% CI 38.5% to 53.8%) in the EVT group; the corresponding ABI-based LBP rates were 71.5% (95% CI 61.8% to 81.2%) and 44.0% (95% CI 37.3% to 50.7%). Conclusion: LBP is an important concept in the new global vascular guidelines for assessing the anatomic and hemodynamic status of CLTI patients. The present study found that LBP was significantly lower in the EVT group vs the bypass surgery group.

Efficiency of the Endovascular Correction of Clinically Evident Degrees of Chronic Obliterating Lower Limb Diseases in Multisegment Lesions

Objective: to evaluate the efficiency and extent of endovascular revascularization in patients with multisegment lesions in chronic obliterating diseases of the lower limb arteries.Material and methods. The outcomes of the endovascular correction of multisegment lesions of the lower limb arteries were analyzed in 10 patients. Results. After the treatment the patients revealed a statistically significant change (increase of the value) of the ankle-brachial index (ABI) (p = 0.001). The ABI value after the surgical intervention amounted to 0.81 (0.71; 0.87), which was connected with a favourable prognosis for such patients. Аccording to the established criteria, the outcomes of the interventions comprised the decrease of the degree of chronic arterial insufficiency (p &lt; 0.01), all the patients were discharged having no clinical manifestations of critical lower limb ischemia or decreased evidence of intermittent claudication.Conclusion. The majority of patients with clinically evident ischemia of the lower limbs suffer from multisegment arterial lesion (the number of the segments exceeds 2), which entails the need of multiple corrections in one patient. Meanwhile, the evaluation of the treatment results is possible only in the postoperative period according to the indirect criteria. Therefore, during the operation there arises the need to develop a method of the objective intraoperative evaluation of the extent and efficiency of the performed correction of arterial lesions on each segment.

Perfusion Analysis of the Foot in Patients With Critical Limb Ischemia Before and After Revascularization and Predictive Value on Amputation-Free Survival (The Delta-Perf Study)

Introduction: Critical limb ischemia (CLI) is frequently leading to major amputations. One of the key points to prevent limb loss is to restore a good vascularization of the foot, usually thanks to endovascular means. However, there is no consensual indicator easily available in the operating room to estimate if the limb revascularization will be enough or not to prevent amputation. This study aims at demonstrating if differences in foot perfusion observed on angiographic runs performed before and after revascularization could be used to estimate the quality of the revascularization and predict limb salvage. Methods: This is a prospective monocentric study enrolling patients with CLI (Rutherford 4, 5 and 6) eligible to an endovascular or hybrid revascularization. Exclusion criteria are represented by patients with severe chronic renal impairment (GFR< 30mL/min) in the absence of dialysis or with expected major amputation at short-term. All procedures are performed in a modern hybrid room with high-quality imaging. Demographics, wound classification (according to the WIfI classification), pre-operative brachial-ankle index, brachial-toe index and procedural data are monitored. Angiographies are performed according to a standardized protocol to analyze the difference in foot perfusion before and after revascularization. Patients are scheduled for systematic follow-up at 1, 3, 6 and 12 months. Main outcome is freedom from major amputation. Secondary outcomes include wound healing, secondary interventions and overall mortality. This trial is registered on ClinicalTrials.gov (NCT03810469). Results: Enrollment started in February 2019 and will continue until January 2021. The study aims at including at least 200 patients. Intermediate analyses are scheduled at one and two years. Final report is expected in 2022. Conclusion: The DELTA-PERF study aims at correlating the differences in foot perfusion on angiographic runs before and after endovascular revascularization in patients with CLI to the survival without major amputation. This method could be directly available in the operating room to optimize revascularizations. Disclosure: Nothing to disclose