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Published on: September 22, 2020
Endothelial function in patients with critical and non-critical limb ischemia undergoing endovascular treatment
Paweł Kaczmarczyk1, Marzena Frołow1,2, Rafał Januszek3,4
1Department of Angiology, Jagiellonian University Medical College, Kraków, Poland.
Insights
Critical limb ischemia (CLI) patients showed improved clinical outcomes after percutaneous transluminal angioplasty (PTA) but no significant changes in endothelial function. Baseline intima-media thickness predicted adverse events in CLI patients.
Area of Science:
- Vascular Medicine
- Interventional Cardiology
- Peripheral Artery Disease Research
Background:
- Critical limb ischemia (CLI) represents the advanced stage of peripheral arterial disease (PAD).
- CLI patients experience poorer treatment outcomes and higher healthcare costs compared to non-CLI patients.
- Understanding endothelial function and clinical trajectory post-intervention is crucial for managing PAD.
Purpose of the Study:
- To compare endothelial function and clinical outcomes in CLI versus non-CLI patients following percutaneous transluminal angioplasty (PTA).
- To evaluate the impact of PTA on endothelial markers and disease progression in different PAD severity groups.
- To identify predictors of adverse events in CLI patients undergoing PTA.
Main Methods:
- Prospective follow-up study involving 30 CLI and 40 non-CLI patients undergoing PTA.
- Endothelial function assessed via flow-mediated dilation (FMD) and reactive hyperemia index (RHI).
- Peripheral artery disease progression evaluated using ankle-brachial index, toe-brachial index, and Rutherford scale, with assessments at baseline and 1, 3, 6, and 12 months post-PTA.
Main Results:
- No significant baseline differences in endothelial function between CLI and non-CLI groups.
- PTA did not induce significant changes in FMD or RHI in either group.
- A significant difference in RHI changes was observed between groups at 1 and 6 months post-PTA (P=0.01).
- Larger baseline intima-media thickness (IMT) in CLI patients predicted increased re-interventions (P=0.01) and major adverse events (P=0.03).
- CLI patients demonstrated a greater reduction in Rutherford scale scores post-PTA (P<0.001).
Conclusions:
- Baseline IMT is a significant predictor of re-interventions and major adverse events in CLI patients.
- While PTA did not alter endothelial function in either group, distinct changes in RHI were noted between CLI and non-CLI patients.
- CLI patients experience better clinical improvement based on the Rutherford scale after PTA.
Background:
Critical limb ischemia (CLI) is the most advanced stage of peripheral arterial disease. CLI patients, compared to non-CLI, achieve worse treatment outcomes and generate higher costs.
Aims:
The aim of the study was to compare endothelial function and clinical outcomes in CLI and non-CLI patients after percutaneous transluminal angioplasty (PTA).
Methods:
In this prospective, follow-up study, 30 CLI patients and 40 non-CLI patients underwent PTA. Endothelial function was assessed based on flow mediated dilatation (FMD), reactive-hyperemia index (RHI), while the ankle-brachial index, toe-brachial index and the Rutherford scale were used for peripheral artery disease progression evaluation. The results were assessed before PTA, as well as 1, 3, 6 and 12 months after the procedure.
Results:
There were no differences at the baseline regarding to endothelial function between both groups. Neither FMD nor RHI changed after PTA in any of the groups, although there was a difference in median RHI value between CLI and non-CLI patients regarding the 1st and 6th month of the follow-up (RHI6-RHI1 = 0.08 in CLI and -0.15 in non-CLI; P = 0.01). The larger baseline intima-media thickness (IMT) in the CLI group allowed to predict a greater number of re-intervention (P = 0.01) and major adverse event rates (P = 0.03). CLI patients presented larger decrease in the Rutherford scale compared to non-CLI (P <0.001).
Conclusions:
Baseline IMT was predictive for re-interventions and major adverse event rates. Although neither of groups exhibited significant changes in endothelial function, we proved differences between them regarding to changes in RHI.
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