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Toe pressure predicts outcomes after revascularization in CLI
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Toe pressure was a predictor of future major adverse limb events in patients with critical limb ischemia who underwent revascularization, according to new data from the IN.PACT DEEP trial.
Researchers assessed the association between ankle pressure and toe pressure with major adverse limb events in patients with CLI from the IN.PACT DEEP trial, which compared percutaneous transluminal angioplasty with a drug-eluting balloon (In.Pact Amphirion, Medtronic). Of the 358 patients in the trial, 270 had ankle pressure measurements before and after the procedure, and 44 had toe pressure measurements before and after the procedure.
Tarek A. Hammad, MD, from the division of cardiology at the University of Texas Health at San Antonio, and colleagues evaluated whether the change in ankle and toe pressures in response to treatment with percutaneous transluminal angioplasty or DEB affected major adverse limb events, defined as target limb revascularization, amputation or death, at 1 year.
After revascularization, mean change in ankle pressure was 33 mm Hg and mean change in toe pressure was 13 mm Hg.
The researchers found that patients with an improvement in ankle pressure more than 73 mm Hg or an improvement in toe pressure more than 1 mm Hg had the lowest incidence of major adverse limb events (23%), whereas those whose toe pressure failed to improve by more than 1 mm Hg had the highest incidence (50%).
After adjustment for various factors, increase in ankle pressure more than 73 mm Hg was not significantly associated with fewer major adverse limb events (adjusted HR = 0.63; 95% CI, 0.32-1.25), but improvement in toe pressure more than 1 mm Hg was (aHR = 0.15; 95% CI, 0.04-0.57), according to the researchers.
“Other current or future technologies may help guide intraprocedural revascularization and provide a more objective assessment of the quality of endovascular revascularization in the near future,” Hammad and colleagues wrote. – by Erik Swain
Disclosures: The original IN.PACT DEEP study was funded by Medtronic. Hammad reports he has no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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