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Clinical impact of improvement in the ankle–brachial index after endovascular therapy for peripheral arterial disease

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Abstract

Predictive ability of changes in the ankle–brachial index (ABI) after revascularization for long-term clinical outcomes remains unclear. Pre- and postprocedural ABI were recorded for 1307 consecutive patients who underwent their first successful EVT for symptomatic aortoiliac (n = 710) or femoropopliteal (n = 597) lesions. The patients were divided into two groups according to the increase in ABI: ∆ABI ≥ 0.15 (n = 980) and ∆ABI < 0.15 (n = 327). We investigated the association between ABI improvement after EVT and long-term clinical outcomes. The clinical outcome measures included all-cause mortality, myocardial infarction, stroke, target limb revascularization, EVT for target lesion revascularization, major amputation of the target limb, and a composite endpoint that included both target limb revascularization and major amputation. All-cause mortality was significantly lower in the ∆ABI ≥ 0.15 group than in the ∆ABI < 0.15 group [crude hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.60–0.98, P = 0.03]; however, this was no longer statistically significant after adjusting for baseline characteristics (adjusted HR 0.82, 95% CI 0.63–1.07, P = 0.14). A composite of target limb revascularization and major amputation was less often observed at 10 years in the ΔABI ≥ 0.15 group (258 patients, 38%) compared with the ΔABI < 0.15 group (112 patients, 59%; adjusted HR 0.54, 95% CI 0.42–0.68, P < 0.001), mainly because of a lower risk of target limb revascularization (adjusted HR 0.54, 95% CI 0.42–0.69, P < 0.001). No significant interactions were noted with regard to the locations of the treated lesions (P for the interaction, 0.13) or preprocedural ABI (P for the interaction, 0.40). An increase of ABI ≥ 0.15 after successful EVT was an independent predictor for freedom from a composite of target limb revascularization and major amputation, irrespective of the locations of the treated lesions and the preprocedural ABI.

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References

  1. Fakhry F, Spronk S, van der Laan L, Wever JJ, Teijink JAW, Hoffmann WH, Smits TM, van Brussel JP, Stultiens GNM, Derom A, den Hoed PT, Ho GH, van Dijk LC, Verhofstad N, Orsini M, van Petersen A, Woltman K, Hulst I, van Sambeek MRHM, Rizopoulos D, Rouwet EV, Hunink MGM (2015) Endovascular revascularization and supervised exercise for peripheral artery disease and intermittent claudication: a randomized clinical trial. JAMA 314:1936–1944

    Article  CAS  Google Scholar 

  2. Fowkes FGR, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, Norman PE, Sampson UKA, Williams LJ, Mensah GA, Criqui MH (2013) Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 382:1329–1340

    Article  Google Scholar 

  3. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME (2017) 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation 135:e726–e779

    PubMed  Google Scholar 

  4. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, TASC II Working Group (2007) Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 45(Suppl S):S5–67

    Article  Google Scholar 

  5. US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng C-W, Wong JB (2018) Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle-brachial index: US preventive services task force recommendation statement. JAMA 320:177–183

    Article  Google Scholar 

  6. Diehm C, Allenberg JR, Pittrow D, Mahn M, Tepohl G, Haberl RL, Darius H, Burghaus I, Trampisch HJ, German Epidemiological Trial on Ankle Brachial Index Study Group (2009) Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation 120:2053–2061

    Article  Google Scholar 

  7. Resnick HE, Lindsay RS, McDermott MM, Devereux RB, Jones KL, Fabsitz RR, Howard BV (2004) Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation 109:733–739

    Article  Google Scholar 

  8. Forés R, Alzamora MT, Pera G, Baena-Díez JM, Mundet-Tuduri X, Torán P (2018) Contribution of the ankle-brachial index to improve the prediction of coronary risk: the ARTPER cohort. PLoS One 13:e0191283

    Article  Google Scholar 

  9. Velescu A, Clara A, Peñafiel J, Ramos R, Marti R, Grau M, Dégano IR, Marrugat J, Elosua R, REGICOR Study Group (2015) Adding low ankle brachial index to classical risk factors improves the prediction of major cardiovascular events. The REGICOR study. Atherosclerosis 241:357–363

    Article  Google Scholar 

  10. Agarwal SK, Kasula S, Hacioglu Y, Ahmed Z, Uretsky BF, Hakeem A (2016) Utilizing Post-intervention fractional flow reserve to optimize acute results and the relationship to long-term outcomes. JACC Cardiovasc Interv 9:1022–1031

    Article  Google Scholar 

  11. McDermott MM, Kibbe M, Guralnik JM, Pearce WH, Tian L, Liao Y, Zhao L, Criqui MH (2013) Comparative effectiveness study of self-directed walking exercise, lower extremity revascularization, and functional decline in peripheral artery disease. J Vasc Surg 57:990.e1–996.e1

    Article  Google Scholar 

  12. Je HG, Kim BH, Cho KI, Jang JS, Park YH, Spertus J (2015) Correlation between patient-reported symptoms and ankle-brachial index after revascularization for peripheral arterial disease. Int J Mol Sci 16:11355–11368

    Article  Google Scholar 

  13. Stoner MC, Calligaro KD, Chaer RA, Dietzek AM, Farber A, Guzman RJ, Hamdan AD, Landry GJ, Yamaguchi DJ, Society for Vascular Surgery (2016) Reporting standards of the society for vascular surgery for endovascular treatment of chronic lower extremity peripheral artery disease. J Vasc Surg 64:e1–e21

    Article  Google Scholar 

  14. Reed GW, Young L, Bagh I, Maier M, Shishehbor MH (2017) Hemodynamic assessment before and after endovascular therapy for critical limb ischemia and association with clinical outcomes. JACC Cardiovasc Interv 10:2451–2457

    Article  Google Scholar 

  15. Sukul D, Grey SF, Henke PK, Gurm HS, Grossman PM (2017) Heterogeneity of ankle-brachial indices in patients undergoing revascularization for critical limb ischemia. JACC Cardiovasc Interv 10:2307–2316

    Article  Google Scholar 

  16. Hong S-J, Ko Y-G, Shin D-H, Kim J-S, Kim B-K, Choi D, Hong M-K, Jang Y (2015) Outcomes of spot stenting versus long stenting after intentional subintimal approach for long chronic total occlusions of the femoropopliteal artery. JACC Cardiovasc Interv 8:472–480

    Article  Google Scholar 

  17. Soga Y, Iida O, Kawasaki D, Yamauchi Y, Suzuki K, Hirano K, Koshida R, Kamoi D, Tazaki J, Higashitani M, Shintani Y, Yamaoka T, Okazaki S, Suematsu N, Tsuchiya T, Miyashita Y, Shinozaki N, Takahashi H, on behalf of REAL-AI investigators (2012) Contemporary outcomes after endovascular treatment for aorto–iliac artery disease. Circ J 76:2697–2704

    Article  Google Scholar 

  18. Soga Y, Iida O, Hirano K, Yokoi H, Nanto S, Nobuyoshi M (2010) Mid-term clinical outcome and predictors of vessel patency after femoropopliteal stenting with self-expandable nitinol stent. J Vasc Surg 52:608–615

    Article  Google Scholar 

  19. Patel MR, Conte MS, Cutlip DE, Dib N, Geraghty P, Gray W, Hiatt WR, Ho M, Ikeda K, Ikeno F, Jaff MR, Jones WS, Kawahara M, Lookstein RA, Mehran R, Misra S, Norgren L, Olin JW, Povsic TJ, Rosenfield K, Rundback J, Shamoun F, Tcheng J, Tsai TT, Suzuki Y, Vranckx P, Wiechmann BN, White CJ, Yokoi H, Krucoff MW (2015) Evaluation and treatment of patients with lower extremity peripheral artery disease: consensus definitions from Peripheral Academic Research Consortium (PARC). J Am Coll Cardiol 65:931–941

    Article  Google Scholar 

  20. Soga Y, Takahara M, Iida O, Suzuki K, Hirano K, Kawasaki D, Shintani Y, Yamaoka T, Ando K (2015) Relationship between primary patency and lesion length following bare nitinol stent placement for femoropopliteal disease. J Endovasc Ther 22:862–867

    Article  Google Scholar 

  21. Iida O, Soga Y, Hirano K, Suzuki K, Yokoi H, Nobuyoshi M, Muramatsu T, Inoue N, Nanto S, Uematsu M (2011) Long-term outcomes and risk stratification of patency following nitinol stenting in the femoropopliteal segment: retrospective multicenter analysis. J Endovasc Ther 18:753–761

    Article  Google Scholar 

  22. Meneveau N, Souteyrand G, Motreff P, Caussin C, Amabile N, Ohlmann P, Morel O, Lefrançois Y, Descotes-Genon V, Silvain J, Braik N, Chopard R, Chatot M, Ecarnot F, Tauzin H, Van Belle E, Belle L, Schiele F (2016) Optical coherence tomography to optimize results of percutaneous coronary intervention in patients with non-ST-elevation acute coronary syndrome: results of the multicenter, randomized DOCTORS study (does optical coherence tomography optimize results of s. Circulation 134:906–917

    Article  Google Scholar 

  23. Kokkinos P, Faselis C, Myers J, Sui X, Zhang J, Blair SN (2014) Age-specific exercise capacity threshold for mortality risk assessment in male veterans. Circulation 130:653–658

    Article  Google Scholar 

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Author notes

  1. Tomonori Katsuki and Kyohei Yamaji contributed equally.

Authors and Affiliations

  1. Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, 802-0001, Japan

    Tomonori Katsuki, Kyohei Yamaji, Yusuke Tomoi, Seiichi Hiramori, Yoshimitsu Soga & Kenji Ando

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  1. Tomonori Katsuki
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  2. Kyohei Yamaji
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  3. Yusuke Tomoi
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  5. Yoshimitsu Soga
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Correspondence to Tomonori Katsuki.

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Katsuki, T., Yamaji, K., Tomoi, Y. et al. Clinical impact of improvement in the ankle–brachial index after endovascular therapy for peripheral arterial disease. Heart Vessels 35, 177–186 (2020). https://doi.org/10.1007/s00380-019-01485-z

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