Propensity-matched analysis does not support angiosome-guided revascularization of multilevel peripheral artery disease (PAD)

Background: This retrospective comparative cohort study evaluated the clinical outcome of angiosome-guided endovascular arterial reconstructions in chronic limb-threatening ischemia (CLTI) due to multilevel peripheral artery disease (PAD). Methods: Patients treated in an endovascular fashion for CLTI with tissue loss due to multilevel PAD were analyzed. Limbs were classified as having undergone either angiosome-guided (direct) revascularization (DR) or nonangiosomic (indirect) revascularization (IR). DR was defined as uninterrupted in-line flow to the affected angiosome, revascularization through the pedal arch was also considered direct. Groups were adjusted with propensity score (PS) matching and compared for amputation-free survival (AFS), freedom from major adverse limb events (MALE), and healing rate at 12 months. Results: A total of 174 patients (81 men, mean age 70.0 ± 10.4 y) were included. PS matching produced two groups of 55 patients each: DR (24 men, mean age 71.7 ± 10.7 y) and IR (26 men, mean age 72.0 ± 9.4 y). The matched groups had no significant differences in baseline variables. At 12 months there were no significant differences in AFS (73.2% vs 71.6%; p = 0.841), freedom from MALE (71.7% vs 66.1%; p = 0.617), and healing rate (72.7% vs 72.0%; p = 1.000) between DR and IR, respectively. Conclusion: This study failed to support the use of angiosome concept in CLTI due to multilevel disease.

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Smoking cessation is associated with decreased mortality and improved amputation-free survival among patients with symptomatic peripheral artery disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2014.08.064 ◽

2014 ◽

Vol 60 (6) ◽

pp. 1565-1571 ◽

Cited By ~ 74

Author(s):

Ehrin J. Armstrong ◽

Julie Wu ◽

Gagan D. Singh ◽

David L. Dawson ◽

William C. Pevec ◽

...

Keyword(s):

Smoking Cessation ◽

Peripheral Artery Disease ◽

Peripheral Artery ◽

Free Survival ◽

Artery Disease

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Abstract MP17: Galectin-3 and Subsequent Risk of Lower-extremity Peripheral Artery Disease: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.137.suppl_1.mp17 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Kunihiro Matsushita ◽

Chao Yang ◽

Shoshana H Ballew ◽

John W McEvoy ◽

Maya Salameh ◽

...

Keyword(s):

Lower Extremity ◽

Peripheral Artery Disease ◽

Limb Ischemia ◽

Continuous Variable ◽

Tissue Loss ◽

Peripheral Artery ◽

Cox Models ◽

Galectin 3 ◽

Table Model ◽

Artery Disease

Background: Galectin-3 is involved in the regulation of inflammation and the formation of fibrosis and has been liked to atherosclerosis. However, there are no studies investigating prospective associations of galectin-3 with incidence of lower-extremity peripheral artery disease (PAD). Methods: Among 9,827 ARIC participants without a history of PAD, we investigated whether galectin-3 (measured at visit 4 [1996-98]) was associated with incident clinical PAD through 2013, defined as hospitalizations with PAD diagnosis or leg revascularization. We defined PAD cases with rest pain or tissue loss as critical limb ischemia (CLI). We constructed Cox models with galectin-3 modeled categorically (quartiles) and continuously (log transformed). Results: During a median follow-up of 15.8 years, 287 participants developed PAD (105 incident CLI cases). In demographically adjusted models, galectin-3 demonstrated a dose-response association with incident PAD: hazard ratios (HRs) 2.55 (95% CI 1.80-3.61) and 1.69 (1.18-2.41) for the highest and second highest quartiles, as compared to the lowest quartile (Table; Model 1). Additional adjustment for traditional cardiovascular risk factors attenuated the associations, although the highest quartile remained borderline significant (HR 1.44 [0.99-2.07], p=0.051, Table: Model 2) and galectin-3 as a continuous variable remained significant (1.15 [1.02-1.29]). Similar results were observed for the association of galectin-3 with CLI. Conclusions: Galectin-3 was modestly associated with future risk of clinical PAD events in a community-based cohort, supporting the involvement of inflammation and fibrosis in the development of clinical PAD.

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