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Change in ankle-brachial index, toe-brachial index predicts outcomes in CLI
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Changes in ankle-brachial index and toe-brachial index were significant predictors of clinical outcomes in patients with critical limb ischemia after endovascular revascularization, according to an observational study.
Researchers conducted an observational study of 218 patients with Rutherford class 5 or 6 CLI who had endovascular therapy to determine whether change in ankle-brachial index and/or toe-brachial index predicted clinical outcomes, and if so, how much of a change.
The outcomes of interest were wound healing, major adverse limb events and repeat revascularization. Median follow-up was 257 days.
After adjustment for age, diabetes, glomerular filtration rate, smoking, Rutherford class and baseline ankle-brachial index or toe-brachial index, static postprocedure ankle-brachial index (HR = 1.21; 95% CI, 0.77-1.89) and postprocedure toe-brachial index (HR = 1.49; 95% CI, 0.98-2.27) were not associated with wound healing, Grant W. Reed, MD, MSc, from the Heart and Vascular Institute, department of cardiovascular medicine, Cleveland Clinic, and colleagues wrote.
However, they wrote, change in ankle-brachial index of at least 0.23 independently predicted wound healing (HR = 1.87; 95% CI, 1.12-3.15) and reduced risk for repeat revascularization (HR = 0.4; 95% CI, 0.19-0.84), but not major adverse limb events.
Likewise, change in toe-brachial index of at least 0.21 independently predicted wound healing (HR = 1.63; 95% CI, 1.02-2.59) and reduced risk for major adverse limb events (HR = 0.27; 95% CI, 0.09-0.77) but not repeat revascularization.
“Our results provide support to noninvasive hemodynamic assessment of lower extremity perfusion after endovascular therapy,” Reed and colleagues wrote. “These data may help guide physicians and organizations in offering personalized postprocedure care to patients with CLI, tailored by their objective hemodynamic data.”
In a related editorial, Christopher J. White, MD, and Rajan A.J. Patel, MD, both from the Ochsner Clinical School of the University of Queensland in Brisbane, Australia, and the department of cardiology of the Ochsner Medical Center, New Orleans, wrote that because many patients were lost to follow-up, “these data are hypothesis-generating and will need confirmation with additional patient data.”
However, White, a member of the Cardiology Today’s Intervention Editorial Board, and Patel wrote that “this information should make us reconsider our usual clinical practice of accepting an increase in [ankle-brachial index] of 0.15 as a marker for success following revascularization of CLI patients.” – by Erik Swain
Disclosures: One author reports he serves as a consultant and educator for Abbott Vascular, Boston Scientific, Medtronic and Spectranetics. Patel and White report no relevant financial disclosures.
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