International Angiology 2021 Mar 04

DOI: 10.23736/S0392-9590.21.04523-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

A prognostic risk score for major amputation in dialysis patients with chronic limbthreatening ischemia after endovascular revascularization

Luca FARCHIONI ¹ ✉, Stefano GENNAI ¹, Enrico GIULIANI ², Antonietta CUCCÍ ¹, Antonio LAURICELLA ¹, Nicola LEONE ¹, Roberto SILINGARDI ¹

¹ Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy; ² Department of Anaesthsiology and Intensive Care, Policlinico di Modena, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy

BACKGROUND: Almost 38% of all patients with end-stage chronic kidney disease (CKD) have peripheral arterial disease of the lower limbs that can lead to chronic limb threatening ischemia (CLTI). The aim of this study was to assess the impact of several factors to conduct a stratification of the amputation risk in CKD patients with CLTI receiving endovascular revascularization.
METHODS: Observational, retrospective, single-center study of patients treated from 2010 to 2016. The primary endpoint was the major amputation. The study included adult CKD dialysis patients affected by CLTI (rest pain and/or trophic lesions) with indication to endovascular revascularization and excluded for open repair.
RESULTS: A total of 82 patients were considered (58 men [70.7%], 24 women [29.3%] mean age 70.4 ±15.0 years). The number of major amputations was 28 (34.1%). The arterial lesion severity (TASC II-classification) and the trophic lesions extension (WIfI classification) were significantly associated with major amputation (OR and 95%CI, 1.20 [1.07-1.34], p= .001; 2.65 [1.49-4.72], p= 0.001; respectively). Based on the abovementioned characteristics, a prognostic score was proposed to predict the major amputation risk. A score ≥23 was associated with a 67.6% probability of amputation in the following 12 months.
CONCLUSIONS: The CLTI revascularization is associated with poor outcomes in CKD patients. The present clinical score provided a pragmatic tool to calculate the major amputation risk. An elevated score could facilitate the decision-making process in order to perform an endovascular treatment vs conservative approach.

KEY WORDS: Peripheral artery disease; Percutaneous Transluminal Angioplasty; Amputation; End-Stage kidney disease; Chronic kidney failure; Hemodialysis