Devraj Sukul1, Scott F Grey1, Peter K Henke2, Hitinder S Gurm3, P Michael Grossman4. 1. Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan. 2. Department of Surgery, Division of Vascular Surgery, University of Michigan, Ann Arbor, Michigan; VA Ann Arbor Healthcare System, Ann Arbor, Michigan. 3. Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; VA Ann Arbor Healthcare System, Ann Arbor, Michigan. 4. Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; VA Ann Arbor Healthcare System, Ann Arbor, Michigan. Electronic address: pagross@umich.edu.
Abstract
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.
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%) SRpatients. 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.
Authors: L Norgren; W R Hiatt; J A Dormandy; M R Nehler; K A Harris; F G R Fowkes; Kevin Bell; Joseph Caporusso; Isabelle Durand-Zaleski; Kimihiro Komori; Johannes Lammer; Christos Liapis; Salvatore Novo; Mahmood Razavi; Johns Robbs; Nicholaas Schaper; Hiroshi Shigematsu; Marc Sapoval; Christopher White; John White; Denis Clement; Mark Creager; Michael Jaff; Emile Mohler; Robert B Rutherford; Peter Sheehan; Henrik Sillesen; Kenneth Rosenfield Journal: Eur J Vasc Endovasc Surg Date: 2006-11-29 Impact factor: 7.069
Authors: Matthew A Allison; Elena Ho; Julie O Denenberg; Robert D Langer; Anne B Newman; Richard R Fabsitz; Michael H Criqui Journal: Am J Prev Med Date: 2007-04 Impact factor: 5.043
Authors: Geoffrey H Tison; Chiadi E Ndumele; Gary Gerstenblith; Matthew A Allison; Joseph F Polak; Moyses Szklo Journal: Am J Cardiol Date: 2011-03-04 Impact factor: 2.778
Authors: Victor Aboyans; Michael H Criqui; Robyn L McClelland; Matthew A Allison; Mary McGrae McDermott; David C Goff; Teri A Manolio Journal: J Vasc Surg Date: 2007-02 Impact factor: 4.268
Authors: Victor Aboyans; Elena Ho; Julie O Denenberg; Lindsey A Ho; Loki Natarajan; Michael H Criqui Journal: J Vasc Surg Date: 2008-08-09 Impact factor: 4.268
Authors: Brian M Renard; Milan Seth; David Share; Herb D Aronow; Eugene W Laveroni; Michele De Gregorio; Sachinder S Hans; Peter K Henke; Hitinder S Gurm; P Michael Grossman Journal: Vasc Med Date: 2015-08-31 Impact factor: 3.239
Authors: Joseph L Mills; Michael S Conte; David G Armstrong; Frank B Pomposelli; Andres Schanzer; Anton N Sidawy; George Andros Journal: J Vasc Surg Date: 2013-10-12 Impact factor: 4.268
Authors: Brian P Davidson; James Hodovan; O'Neil R Mason; Federico Moccetti; Avi Gupta; Matthew Muller; J Todd Belcik; Brian H Annex; Jonathan R Lindner Journal: J Am Soc Echocardiogr Date: 2019-06-22 Impact factor: 5.251
Authors: Joshua A Beckman; Meredith S Duncan; Scott M Damrauer; Quinn S Wells; Joey V Barnett; David H Wasserman; Roger J Bedimo; Adeel A Butt; Vincent C Marconi; Jason J Sico; Hilary A Tindle; Marc P Bonaca; Aaron W Aday; Matthew S Freiberg Journal: Circulation Date: 2019-07-08 Impact factor: 29.690
Authors: Terence E Ryan; Dean J Yamaguchi; Cameron A Schmidt; Tonya N Zeczycki; Saame Raza Shaikh; Patricia Brophy; Thomas D Green; Michael D Tarpey; Reema Karnekar; Emma J Goldberg; Genevieve C Sparagna; Maria J Torres; Brian H Annex; P Darrell Neufer; Espen E Spangenburg; Joseph M McClung Journal: JCI Insight Date: 2018-11-02
Authors: Sanjay Misra; Mehdi H Shishehbor; Edwin A Takahashi; Herbert D Aronow; Luke P Brewster; Matthew C Bunte; Esther S H Kim; Jonathan R Lindner; Kathleen Rich Journal: Circulation Date: 2019-08-12 Impact factor: 29.690
Authors: Poghni A Peri-Okonny; Jingyan Wang; Kensey L Gosch; Manesh R Patel; Mehdi H Shishehbor; David L Safley; J Dawn Abbott; Herbert D Aronow; Carlos Mena-Hurtado; Qurat-Ul-Ain Jelani; Yuanyuan Tang; Matthew Bunte; Clementine Labrosciano; John F Beltrame; John A Spertus; Kim G Smolderen Journal: Circ Cardiovasc Qual Outcomes Date: 2021-05-05
Authors: Beau M Hawkins; Jun Li; Luke R Wilkins; Teresa L Carman; Amy B Reed; David G Armstrong; Philip Goodney; Christopher J White; Aaron Fischman; Marc L Schermerhorn; Dmitriy N Feldman; Sahil A Parikh; Mehdi H Shishehbor Journal: Vasc Med Date: 2022-04-25 Impact factor: 4.739
Authors: John J Squiers; Jeffrey E Thatcher; David S Bastawros; Andrew J Applewhite; Ronald D Baxter; Faliu Yi; Peiran Quan; Shuai Yu; J Michael DiMaio; Dennis R Gable Journal: J Vasc Surg Date: 2021-07-24 Impact factor: 4.268