A prognostic risk score for major amputation in dialysis patients with chronic limb-threatening ischemia after endovascular revascularization

Abstract

Background: Almost 38% of all patients with end-stage chronic kidney disease (CKD) have peripheral arterial disease of the lower limbs that can lead to chronic limb threatening ischemia (CLTI). The aim of this study was to assess the impact of several factors to conduct a stratification of the amputation risk in CKD patients with CLTI receiving endovascular revascularization. Methods: Observational, retrospective, single-center study of patients treated from 2010 to 2016. The primary endpoint was the major amputation. The study included adult CKD dialysis patients affected by CLTI (rest pain and/or trophic lesions) with indication to endovascular revascularization and excluded for open repair. Results: A total of 82 patients were considered (58 men [70.7%], 24 women [29.3%] mean age 70.4±15.0 years). The number of major amputations was 28 (34.1%). The arterial lesion severity (TASC II-classification) and the trophic lesions extension (WIfI classification) were significantly associated with major amputation (OR and 95%CI, P=0.001;.72], P=0.001; respectively). Based on the abovementioned characteristics, a prognostic score was proposed to predict the major amputation risk. A score ≥23 was associated with a 67.6% probability of amputation in the following 12 months. Conclusions: The CLTI revascularization is associated with poor outcomes in CKD patients. The present clinical score provided a pragmatic tool to calculate the major amputation risk. An elevated score could facilitate the decision-making process in order to perform an endovascular treatment vs. conservative approach.

The Impact of Chronic Kidney Disease on Peripheral Artery Disease and Peripheral Revascularization

“… 40 In fact, the WIfI classification provides more insights into the outcomes associated to each operative treatment. 41 The WIfI classification attributes a score to wound (W), ischemia (I), foot infection (f) and a combination of these scores allows to reach a unique categorization into meaningful clinical stages (depicted in Table 1 ). The initial therapeutic strategy of PAD consists in reinforcing preventive measures against adverse CV events.…”

Health-related quality of life outcomes and hospitalization length of stay after micro-fragmented autologous adipose tissue injection in minor amputations for diabetic foot ulceration (MiFrAADiF Trial): results from a randomized controlled single-center clinical trial

“…Such as other heavily diseased conditions, the DFU presented a relevant increase of amputation risk. 7,8 Besides, the presence of DFU decreased significantly the health-related quality of life (HRQoL). 9 In case of DFU, a multidisciplinary approach should be undertaken providing general health advices (including adequate shoes), evaluating glycemic control, excluding vascular and infective issues, and performing adequate dressings.…”