Vascular Health and Risk Management (Jul 2023)

Chronic Limb-Threatening Ischemia in Patients with Type 2 Diabetes: Revascularization Index as a Predictor for Primary Endovascular Intervention Outcome

  • Shatnawi NJ,
  • Al-Zoubi NA,
  • Al-Bakkar LA,
  • Abu-Baker AM,
  • Khader YS,
  • Al-Omari M,
  • El-Heis MA

Journal volume & issue
Vol. Volume 19
pp. 495 – 504

Abstract

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Nawaf J Shatnawi,1 Nabil A Al-Zoubi,1 Lujain A Al-Bakkar,1 Ammar M Abu-Baker,1 Yousef S Khader,2 Mamoon Al-Omari,3 Mowafeq A El-Heis3 1Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Radiology, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Nawaf J Shatnawi, Department of Surgery, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan, Tel + 962 795576267, Email [email protected] Nabil A Al-Zoubi, Department of General Surgery/Vascular Surgery, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan, Tel + 962 795774637, Email [email protected]: Chronic limb-threatening ischemia in patients with diabetes is associated with a high risk of adverse outcomes. The associated co-morbidities, the heterogeneity of foot presentation and the distribution of atherosclerotic lesions led to the emergence of multiple revascularization strategies and scoring systems to improve management outcomes. This study aimed to introduce a new index, the revascularization index (RI), and to assess its predictive value for the outcomes of primary endovascular intervention in patients with type 2 diabetes presenting with chronic limb-threatening ischemia.Patients and Methods: A retrospective electronic medical records review was conducted for patients with type 2 diabetes presenting with chronic limb-threatening ischemia managed at King Abdullah University Hospital by primary endovascular interventions between January 2014 and August 2019. The RI was analyzed for its predictive value for the treatment outcomes.Results: A total of 187 patients were included in this study, with a major lower limb amputation rate of 19.3%. The performance of the RI was excellent in predicting secondary revascularization (AUC = 0.80, 95% CI: 0.73– 0.86, p-value < 0.001), good to predict major amputation (AUC = 0.76, 95% CI: 0.67– 0.85, p-value = 0.047), and poor in predicting death (AUC = 0.46, 95% CI: 0.40– 0.55, p-value = 0.398). RI of < 1.21 was significantly associated with a higher risk of major lower limb amputation (HR = 5.8, 95% CI: 1.25– 26.97, p-value < 0.025), and RI of < 1.3 was associated with a higher risk for secondary revascularization.Conclusion: The RI can be used to predict major adverse lower limb events (MALE). It might be used as a guide for the extent of endovascular interventions for diabetic chronic limb-threatening ischemia with multi-level outflow atherosclerotic disease.Keywords: chronic limb-threatening ischemia, diabetes mellitus, angioplasty, amputation, revascularization index

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