TY - JOUR
T1 - Heterogeneity of Ankle-Brachial Indices in Patients Undergoing Revascularization for Critical Limb Ischemia
AU - Sukul, Devraj
AU - Grey, Scott F.
AU - Henke, Peter K.
AU - Gurm, Hitinder S.
AU - Grossman, P. Michael
N1 - Funding Information:
Dr. Sukul is supported by the National Institutes of Health T32 postdoctoral research training grant (T32-HL007853). This work was supported by the Blue Cross Blue Shield of Michigan and Blue Care Network as part of the Blue Cross Blue Shield of Michigan Value Partnerships program. The funding source supported data collection at each site and funded the data-coordinating center but had no role in study concept, interpretation of findings, or in the preparation, final approval, or decision to submit the manuscript. Although Blue Cross Blue Shield of Michigan (BCBSM) and BMC2 work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. Dr. Grey has received funding from BCBSM. Dr. Henke has received research funding from the National Institutes of Health and BCBSM. Dr. Gurm has received research funding from Blue Cross Blue Shield of Michigan and the National Institutes of Health; and is a consultant for Osprey Medical. Dr. Grossman has received research funding from Blue Cross Blue Shield of Michigan, the National Institutes of Health, and Medtronic Cardiovascular; and was a research investigator in the Edwards Sapien clinical trial. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This study was presented at the 27th Annual Society of Vascular Medicine Scientific Sessions in June 2016 and Dr. Sukul was the recipient of a Young Investigator Award.
Publisher Copyright:
© 2017 American College of Cardiology Foundation
PY - 2017/11/27
Y1 - 2017/11/27
N2 - Objectives This study sought to describe the distribution of pre-intervention treated-limb ankle-brachial indices (ABIs) among patients with critical limb ischemia (CLI) undergoing percutaneous vascular intervention (PVI) or surgical revascularization (SR). Background CLI is diagnosed by the presence of rest pain, tissue ulceration, or gangrene due to chronic arterial insufficiency. It is unclear what fraction of patients with suspected CLI have severe peripheral artery disease (PAD) on noninvasive functional testing. Methods The study included patients who underwent lower extremity revascularization for CLI in a multicenter registry in Michigan from January 2012 through June 2015. ABIs were classified as normal (ABI: 0.91 to 1.40), mild-moderate (ABI: 0.41 to 0.90), and severe (ABI: ≤0.40). Pre- and post-intervention Peripheral Artery Questionnaire summary scores were assessed in a subset of patients. Results Among 10,756 patients with signs or symptoms of CLI, 9,113 (84.7%) underwent PVI and 1,643 (15.3%) underwent SR. ABIs were recorded in 4,972 (54.6%) PVI and 1,012 (61.6%) SR patients. Patients undergoing PVI had higher ABIs than those undergoing SR, with substantial variation in both groups (PVI: 0.72 ± 0.29 vs. SR: 0.61 ± 0.29; p < 0.001). Nearly a quarter of patients with compressible arteries had normal ABIs (24.0%), whereas severe PAD was uncommon (16.5%). A significant improvement in Peripheral Artery Questionnaire scores was noted after intervention across all ABI categories. Conclusions Among patients undergoing revascularization for CLI in contemporary practice, the authors found substantial heterogeneity in pre-intervention ABIs. The disconnect between ABI results and clinical diagnosis calls into question the utility of ABIs in this population and suggests the need for standardization of functional PAD testing.
AB - Objectives This study sought to describe the distribution of pre-intervention treated-limb ankle-brachial indices (ABIs) among patients with critical limb ischemia (CLI) undergoing percutaneous vascular intervention (PVI) or surgical revascularization (SR). Background CLI is diagnosed by the presence of rest pain, tissue ulceration, or gangrene due to chronic arterial insufficiency. It is unclear what fraction of patients with suspected CLI have severe peripheral artery disease (PAD) on noninvasive functional testing. Methods The study included patients who underwent lower extremity revascularization for CLI in a multicenter registry in Michigan from January 2012 through June 2015. ABIs were classified as normal (ABI: 0.91 to 1.40), mild-moderate (ABI: 0.41 to 0.90), and severe (ABI: ≤0.40). Pre- and post-intervention Peripheral Artery Questionnaire summary scores were assessed in a subset of patients. Results Among 10,756 patients with signs or symptoms of CLI, 9,113 (84.7%) underwent PVI and 1,643 (15.3%) underwent SR. ABIs were recorded in 4,972 (54.6%) PVI and 1,012 (61.6%) SR patients. Patients undergoing PVI had higher ABIs than those undergoing SR, with substantial variation in both groups (PVI: 0.72 ± 0.29 vs. SR: 0.61 ± 0.29; p < 0.001). Nearly a quarter of patients with compressible arteries had normal ABIs (24.0%), whereas severe PAD was uncommon (16.5%). A significant improvement in Peripheral Artery Questionnaire scores was noted after intervention across all ABI categories. Conclusions Among patients undergoing revascularization for CLI in contemporary practice, the authors found substantial heterogeneity in pre-intervention ABIs. The disconnect between ABI results and clinical diagnosis calls into question the utility of ABIs in this population and suggests the need for standardization of functional PAD testing.
KW - ankle-brachial index
KW - critical limb ischemia
KW - percutaneous vascular intervention
KW - peripheral artery disease
KW - surgical bypass graft
UR - http://www.scopus.com/inward/record.url?scp=85034965301&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2017.08.026
DO - 10.1016/j.jcin.2017.08.026
M3 - Article
C2 - 29169498
AN - SCOPUS:85034965301
SN - 1936-8798
VL - 10
SP - 2307
EP - 2316
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 22
ER -