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Runoff detected by magnetic resonance angiography as an indicator for better recanalization outcomes in below-the-knee chronic total occlusions in diabetic patients.
- Source :
-
Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2015 Apr; Vol. 22 (2), pp. 243-51. - Publication Year :
- 2015
-
Abstract
- Purpose: To compare the feasibility and efficacy of recanalizing below-the-knee (BTK) chronic total occlusions (CTOs) between patients with good or poor distal runoff based on magnetic resonance angiography (MRA) scans.<br />Methods: Two hundred long-segment BTK CTOs in 171 limbs of 113 diabetic patients (58 men; mean age 69.8±1.9 years) were divided into good distal runoff (GDR: 119 lesions, 98 limbs) or poor distal runoff groups (PDR: 81 lesions, 73 limbs) based on baseline MRA findings. After angioplasty, modified thrombolysis in myocardial ischemia (mTIMI) grades and ankle-brachial index (ABI) were used to assess immediate outcomes. Regularly scheduled duplex or MRA imaging was performed in follow-up. The restenosis and limb salvage rates were compared.<br />Results: The success rates were 93.3% and 87.7% in the GDR and PDR groups, respectively (p=0.21); subintimal angioplasty was more common in the PDR group (93.0% vs. 63.1%, p<0.01). Completion angiography indicated an mTIMI grade 3 blood flow in 71.2% lesions in the GDR patients and in 52.1% in the PDR (p=0.01) group. Improvement in the ABI was greater in the GDR limbs (p<0.001 vs. PDR). Mean imaging follow-up was 10.8±6.9 months in the GDR group and 11.1±6.6 months in the PDR group. Kaplan-Meier analysis showed a better restenosis-free rate in the GDR group (80.6% vs. 61.7%; p=0.02) at 12 months and for lesions with mTIMI grade 3 flow (p<0.01). At 24 months, Kaplan-Meier analysis revealed a better limb salvage rate in the GDR group (84.2% vs. 54.6%; p=0.02).<br />Conclusion: Distal runoff detected using MRA could be a predictor for successful intraluminal recanalization, better distal tissue perfusion, improved long-term patency, and better limb salvage for patients with BTK CTOs.<br /> (© The Author(s) 2015.)
- Subjects :
- Aged
Angiography, Digital Subtraction
Ankle Brachial Index
Blood Flow Velocity
Chronic Disease
Diabetic Angiopathies physiopathology
Disease-Free Survival
Feasibility Studies
Female
Humans
Kaplan-Meier Estimate
Limb Salvage
Male
Middle Aged
Peripheral Arterial Disease physiopathology
Predictive Value of Tests
Regional Blood Flow
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Patency
Angioplasty adverse effects
Diabetic Angiopathies diagnosis
Diabetic Angiopathies therapy
Leg blood supply
Magnetic Resonance Angiography
Peripheral Arterial Disease diagnosis
Peripheral Arterial Disease therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1545-1550
- Volume :
- 22
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists
- Publication Type :
- Academic Journal
- Accession number :
- 25809370
- Full Text :
- https://doi.org/10.1177/1526602815573229