Related Experiment Video
Updated: Oct 31, 2025
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Arterial stiffness predicts amputation and death in patients with chronic limb-threatening ischemia
Daniel Mendes-Pinto1, Maria da Gloria Rodrigues-Machado2, Gustavo Laranjo Avelar3
1Department of Vascular Surgery, Hospital Felício Rocho, Belo Horizonte, Brazil; Postgraduate Department, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil; Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Insights
Arterial stiffness measurements like pulse wave velocity and augmentation pressure, along with ankle-brachial index, can predict major amputation or death in patients with chronic limb-threatening ischemia. These findings aid in risk stratification for better patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Diagnostic Imaging
Background:
- Arterial stiffness indices are established predictors of cardiovascular events in coronary and kidney disease.
- Limited data exists on the prognostic value of arterial stiffness in advanced peripheral arterial disease, specifically chronic limb-threatening ischemia (CLTI).
Purpose of the Study:
- To determine if arterial stiffness indices predict major amputation or death in patients with CLTI.
- To identify hemodynamic variables and arterial stiffness indices that serve as predictors for adverse limb outcomes.
Main Methods:
- Prospective measurement of arterial stiffness using brachial oscillometry in 136 CLTI patients.
- Follow-up for up to 3 years to record limb preservation, major amputation, or death.
- Analysis of hemodynamic variables and arterial stiffness indices as predictors.
Main Results:
- 24% of patients experienced major amputation or death within a mean follow-up of 14 months.
- Elevated pulse wave velocity (PWV), augmentation index, and augmentation pressure (AP) were significantly higher in patients with amputation/death.
- Lower ankle-brachial index (ABI) was also associated with increased risk; multivariable analysis identified PWV, AP, and ABI as significant predictors.
Conclusions:
- Pulse wave velocity (PWV) and augmentation pressure (AP), key arterial stiffness measurements, predict amputation or death in CLTI patients.
- Ankle-brachial index (ABI) is also a significant predictor of these adverse outcomes.
- These indices can aid in risk stratification and management of CLTI.
Objective:
Arterial stiffness indices predict cardiovascular outcomes in patients with coronary or kidney disease; however, there is little data on the prognostic value of arterial stiffness in patients with advanced peripheral arterial disease. We determined whether arterial stiffness indices predict the outcomes of major amputation or death in patients with chronic limb-threatening ischemia (CLTI).
Methods:
Arterial stiffness was prospectively measured using brachial oscillometry in patients with CLTI. After measuring arterial stiffness, patients were followed in 6-month intervals for up to 3 years and evaluated for limb preservation, occurrence of major amputation, or death. Hemodynamic variables and arterial stiffness indices were used to define predictors of amputation or death.
Results:
A total of 136 patients presented with CLTI, and 134 (99%) of these patients required limb revascularization. At the end of follow-up (mean, 14 months), 24 patients (18%) were alive with a major amputation, and mortality was 7% (9 patients); 33 patients (24%) progressed to the combined outcome of major amputation or death. Patients having amputation and/or death (n = 33; 24%) initially presented with elevated pulse wave velocity (PWV) (13.41 ± 1.21 m/s vs 11.54 ± 1.65 m/s; P < .001), elevated augmentation index corrected to 75 beats per minute (40.42 ± 6.65% vs 27.12 ± 9.19%; P < .001), and high augmentation pressure (AP) (29.98 ± 4.32 mm Hg vs 13.40 ± 7.05 mm Hg; P < .001) compared with patients with preserved limbs. The initial ankle-brachial index (ABI) was lower in patients having amputation and/or death (0.43 ± 0.94 vs 0.62 ± 0.12; P < .001). Multivariable analysis identified PWV (odds ratio [OR], 2.62; P = .013), AP (OR, 1.56; P < .001), and ABI (OR, 0.01; P < .001) as predictors of amputation or death. ROC analysis identified patients with PWV ≤12.7 m/s (hazard ratio, 4.71; P < .001), AP ≤22.15 mm Hg (hazard ratio, 13.03; P < .001), or ABI >0.52 with an increased rate of limb preservation.
Conclusions:
PWV and AP, measurements of arterial stiffness, as well as the ABI, predict amputation or death in patients with CLTI.
Related Concept Videos
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:30Peripheral Artery Disease I: Introduction
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Peripheral Artery Disease IV: Nursing Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:27Assessment of the Cardiovascular System III: Palpation
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...