Prediction of Technical Failure of Inframalleolar Angioplasty in Patients with Chronic Limb Threatening Ischaemia
Prediction of Technical Failure of Inframalleolar Angioplasty in Patients with Chronic Limb Threatening Ischaemia
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DOI：
10.1016/j.ejvs.2022.03.040
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发表时间：
2022-06-01
影响因子：
5.7
通讯作者：
Urasawa, Kazushi
中科院分区：
文献类型：
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作者：
Sato, Yusuke;Morishita, Tetsuji;Urasawa, Kazushi
目的：这项研究力求：确定踝下血管成形术（IMA）技术失败的解剖学评估预测因素，开发IMA不成功的预测模型，并研究IMA对慢性肢体威胁性缺血（CLTI）患者临床结局的影响。这项单中心回顾性观察性研究入组了159例CLTI患者，这些患者在2017年11月至2018年5月期间接受了IMA治疗原发闭塞病变。2021.将患者分为IMA失败组（n = 62）和IMA成功组（n = 97）。在多变量分析中，无靶血管流出（OR 39.8，95% CI 10.7 - 148，p <0.001），内侧动脉钙化（MAC）分级（OR 4.91，95% CI 1.40 - 17.3，p = 0.010）和足弓闭塞（OR 5.2，95% CI 1.2 - 22.7，p= 0.030）被确定为IMA技术失败的独立预测因素。风险预测模型的受试者工作特征曲线下面积（AUC）为0.93;在乐观的自举调整后，该值表示校正后的AUC为0.95。成功IMA组的患者在12个月时的伤口愈合比例显著高于失败IMA组（对数秩p = 0.030）。IMA技术失败与伤口愈合比例的显著变化相关（HR 0.59，95% CI 0.37- 0.94，p = 0.030）。结论：无靶血管流出、MAC等级和足弓闭塞是IMA技术失败的独立预测因素。此外，成功的IMA与12个月时更好的伤口愈合结局相关。此外，一个模型，结合这三个预测准确地预测IMA技术故障。
Objective: This study sought to: determine anatomically evaluated predictors of the technical failure of inframalleolar angioplasty (IMA), develop a predictive model for unsuccessful IMA, and investigate the effect of IMA on clinical outcomes in patients with chronic limb threatening ischaemia (CLTI).Methods: This single centre retrospective observational study enrolled 159 patients with CLTI who underwent IMA for de novo occluded lesions between November 2017 and May 2021. These patients were divided into two groups: the Failed IMA group (n = 62) and the Successful IMA group (n = 97).Results: In multivariable analysis, no target vessel outflow (OR 39.8, 95% CI 10.7 - 148, p < .001), medial artery calcification (MAC) grade (OR 4.91, 95% CI 1.40 - 17.3, p = .010), and occluded pedal arch (OR 5.2, 95% CI 1.2 - 22.7, p= .030) were identified as independent predictors of IMA technical failure. The risk prediction model had an area under the receiver operating characteristic curve (AUC) of 0.93; after bootstrapping adjustment for optimism, this value represented a corrected AUC of 0.95. The patients in the Successful IMA group had a significantly higher proportion of wound healing at 12 months than those in the Failed IMA group (log rank p = .030). IMA technical failure was associated with a significant change in the proportion of wound healing (HR 0.59, 95% CI 0.37- 0.94, p = .030).Conclusion: No target vessel outflow, MAC grade, and occluded pedal arch were independent predictors of IMA technical failure. Additionally, successful IMA was associated with better wound healing outcomes at 12 months. Furthermore, a model incorporating these three predictors precisely predicted IMA technical failure.