Increased preoperative pulse pressure predicts procedural complications and mortality in patients who undergo tibial interventions for critical limb ischemia

Abstract

Introduction Pulse pressure is a non-invasive measure of arterial stiffness. Elevated pulse pressure is associated with an increased risk of cardiovascular events and death. The effects of pulse pressure on outcomes after endovascular interventions for critical limb ischemia (CLI), however, are unknown. We thus evaluated whether increased pre-operative pulse pressure was associated with adverse outcomes and mortality in patients undergoing endovascular tibial artery intervention. Methods All patients undergoing endovascular tibial intervention for CLI at a single institution from 2004 to 2014 were included in this study. Pre-operative pulse pressure was derived from measurements obtained in the holding area prior to the procedure. Patients were divided into 2 groups based on pulse pressure, < 80 or ≥ 80. Patient demographics and co-morbidities were documented, and outcomes including procedural complications, repeat intervention, amputation, and mortality were recorded. Multivariable logistic regression was utilized to account for patient demographics and comorbidities. Results Of 371 patients, 186 patients had a pre-operative pulse pressure <80 and 185 had a pre-operative pulse pressure ≥80. No significant differences in patient demographics or comorbidities were identified; however there was a trend toward older age in patients with elevated pulse pressure (70 vs. 72, P = 0.07). On univariate analysis, procedural complications (21% vs. 13%, P = 0.02), reinterventions (26% vs. 17%, P < 0.01), and restenosis (32% vs. 23%, P = 0.03) were more common among patients with pulse pressure ≥ 80. Procedural complications remained significant on multivariate analysis (OR 1.8, 95% CI 1.0-3.1, P = 0.04). There was no difference in 30-day mortality; however increased mortality was seen at 5 years of follow-up (OR: 1.6, 95% CI: 1.0-2.5, P = 0.04) following multivariable analysis. Conclusions Increased pre-operative pulse pressure is associated with procedural complications and increased mortality in patients undergoing endovascular tibial intervention for CLI. It is a marker of increased risk, and may be a suitable target for interventions aimed at improving outcomes in this high risk population.

Association between critical limb ischemia and arterial stiffness measured by brachial artery oscillometry

“…Increased systolic pressure with maintenance of diastolic pressure is associated with an increase in pulse pressure, which is a determinant of PWV, in addition to being associated with cardiovascular complications. 27…”

Upper Extremity Pulse Pressure Predicts Amputation-Free Survival after Lower Extremity Bypass

“…We have recently demonstrated preoperative pulse pressure predicts increased mortality in a subset of patients with chronic limb ischemia undergoing endovascular intervention. 17 Thus, we hypothesize that this finding may extend to vascular surgical patients undergoing open bypass. As such, in this study, we sought to determine whether increased preoperative pulse pressure could predict amputationfree survival after lower extremity bypass.…”

“…Characteristics of the 240-patient cohort were reviewed and stratified by preoperative pulse pressure into those with values <80 or $80 mm Hg as suggested previously. 8,16,17,21 Demographic factors including age, gender, race, body mass index (BMI) were noted, as were preoperative medications, laboratory values, vascular surgical history, and operative characteristics. The laboratory values closest to, but not more than 30 days from the day of surgery were recorded.…”

Aplicabilidade dos marcadores de rigidez arterial na doença arterial periférica

“…Both elevated Cpp and elevated peripheral pulse pressure are associated with increased risk of coronary disease in middle-aged adults and the elderly. 22 However, risk of cardiovascular events is more associated with elevated central pressures. Elevated Cpp is associated with hypertrophy of the left ventricle and carotid atherosclerosis.…”