Key result
Post-procedural estimated ankle brachial pressure index ≥0.9 was associated with significantly improved major adverse limb events (adjusted HR 0.28; 95% CI 0.11-0.74) compared to <0.9.
Why the study?
Ankle brachial pressure index can be estimated (eABPI) using cuffless ankle Doppler ultrasound, but its prognostic value when measured during pre- and post-procedural ultrasound exams to predict clinical outcome after endovascular revascularisations needed evaluation.
Does post-procedural ultrasound-based estimated ankle brachial pressure index (eABPI) predict clinical outcomes in patients with chronic limb-threatening ischaemia after endovascular revascularization?
Observational (n=219)
No
Does post-procedural ultrasound-based estimated ankle brachial pressure index (eABPI) predict clinical outcomes in patients with chronic limb-threatening ischaemia after endovascular revascularization?
Post-procedural ultrasound-based estimated ankle brachial pressure index (eABPI) is a strong predictor of 1-year clinical outcomes in patients with chronic limb-threatening ischaemia, with optimal outcomes seen at values ≥0.9.
Background Ankle brachial pressure index can be estimated (eABPI) using cuffless ankle Doppler ultrasound. We evaluated the prognostic value of eABPI measured during pre- and post-procedural ultrasound exams to predict the clinical outcome after endovascular revascularisations. Methods In this prospective, single-centre, service evaluation, consecutive patients with symptomatic peripheral artery disease undergoing lower limb endovascular revascularisations between July, 26 2018 and January, 13 2022 at Surrey and Sussex Healthcare NHS Trust (Redhill, UK) were analysed. eABPI was determined using the higher acceleration index measured with angle-corrected duplex ultrasound in ankle arteries before and ≤1 month post-procedure. Clinical outcomes (mortality, major amputations, amputation-free survival [AFS], clinically driven target lesion revascularization [cdTLR], major adverse limb events [MALE; cdTLR and major amputation], wound healing) were assessed over 1 year. Findings Of 246 patients treated, for 219 patients (median 75 [IQR 66–83] years) pre- and post-procedural eABPI (0.50 [0.33–0.59] and 0.90 [0.69–1.0], p < 0.0001) were available, respectively. In n = 199 patients with chronic limb-threatening ischaemia (CLTI) Kaplan–Meier survival analyses showed that higher post-procedural, but not pre-procedural, eABPI was associated with favourable AFS, MALE, cdTLR, and wound healing. This was confirmed in Cox regression analysis and remained significant with adjustment for pre-procedural eABPI, age, sex, co-morbidities, treated levels, wound score, and foot infection. Whereas all clinical outcomes, except for survival, were significantly better at ≥0.7 vs <0.7, wound healing (unadjusted: HR 1.7 (95% CI 1.2–2.6), adjusted: HR 2.1 (95% CI 1.3–3.1), cdTLR, and MALE (unadjusted: HR 0.41 (95% CI 0.18–0.93), adjusted: HR 0.28 (95% CI 0.11–0.74) were significantly improved at ≥0.9 vs <0.9. Interpretation Post-procedural eABPI can provide valid, clinically important prognostic and predictive information. Our data indicate that revascularisations should target values of at least 0.9 to achieve optimal outcomes. Future studies need to confirm generalisability and cost-effectiveness in a wider context.
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Rodway et al. (2024) conducted an observational in Symptomatic peripheral artery disease / chronic limb-threatening ischaemia (n=219). Post-procedural estimated ankle brachial pressure index (eABPI) ≥0.9 vs. Post-procedural eABPI <0.9 was evaluated on Major adverse limb events (MALE) (HR 0.28, 95% CI 0.11-0.74). Post-procedural estimated ankle brachial pressure index ≥0.9 was associated with significantly improved major adverse limb events (adjusted HR 0.28; 95% CI 0.11-0.74) compared to <0.9.
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