Korean J Radiol.  2016 Dec;17(6):874-881. 10.3348/kjr.2016.17.6.874.

Predictors for Better Blood-Flow Restoration of Long-Segmental Below-the-Knee Chronic Total Occlusions after Endovascular Therapy in Diabetic Patients

• Song XL
• Zhu YQ
• Lu HT
• Liu F
• Wei LM
• Kang HK
• Zhao JG

• KMID: 2466284
• DOI: http://doi.org/10.3348/kjr.2016.17.6.874

Abstract

OBJECTIVE
To prospectively investigate predictors for good restoration of blood flow of below-the-knee (BTK) chronic total occlusions (CTOs) after endovascular therapy in diabetes mellitus (DM) patients.
MATERIALS AND METHODS
A total of 120 long-segmental (≥ 5 cm) BTK, CTOs in 81 patients who underwent recanalization were included in this study. After angioplasty, blood-flow restoration was assessed using modified thrombolysis in myocardial ischemia grades and classified as good flow (grade 3) and poor flow (grade 1/2). One hundred and six CTOs with successful recanalization were divided into a good flow group (GFG; n = 68) and poor flow group (PFG; n = 38). Multivariate logistic regression analyses were undertaken to determine independent predictors of blood-flow restoration. Receiver operating characteristic curves were constructed to determine the best cutoff value. The prevalence of target-lesion restenosis during follow-up was compared between two groups.
RESULTS
Univariate analyses suggested that CTOs in GFG were characterized by lighter limb ischemia (p = 0.03), shorter course of ischemic symptoms (p < 0.01) and lesion length (p = 0.04), more frequent use of intraluminal angioplasty (p = 0.03), and higher runoff score (p < 0.01) than those in PFG. Multivariate regression analyses suggested that distal runoffs (p = 0.001; odds ratio [OR], 10.32; 95% confidence interval [CI]: 4.082-26.071) and lesion length (p < 0.001; OR, 1.26; 95% CI: 1.091-1.449) were independent predictors for good flow restoration. Kaplan-Meier analyses at 12 months showed a higher prevalence of non-restenosis in GFG (p < 0.01).
CONCLUSION
Distal runoffs and lesion length are independent predictors for good flow restoration for long-segmental BTK, CTOs in DM patients who receive endovascular therapy.

Keyword

Chronic total occlusion; Extremity; Below the knee; Endovascular treatment; Blood flow restoration; Diabetes mellitus; DM

MeSH Terms

Aged
Area Under Curve
Arterial Occlusive Diseases/complications/diagnostic imaging/physiopathology/*therapy
Blood Flow Velocity/*physiology
Chronic Disease
Diabetes Mellitus, Type 2/*complications
Female
Femoral Artery/diagnostic imaging
Humans
Kaplan-Meier Estimate
Knee Joint/*blood supply
Limb Salvage
Logistic Models
Magnetic Resonance Angiography
Male
Middle Aged
Odds Ratio
Predictive Value of Tests
ROC Curve
Regional Blood Flow/physiology
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1 Flow chart of present study. CTOs = chronic total occlusions

• 

  Fig. 2 Images of 71-year-old male patient who had experienced rest pain in left leg for 15 months. CE-MRA revealed long CTOs of anterior and posterior tibial arteries (yellow arrowheads) in left lower limb. Good distal runoffs of CTOs were detected with CE-MRA (yellow wide arrows) (A), which showed similar sensitivity to DSA (B). Anterior tibial artery received intraluminal angioplasty treatment (white arrows). Retrograde intraluminal angioplasty of posterior tibial artery (white arrows) via pedal arch was performed when integrate subintimal recanalization failed (C). Immediate DSA revealed good blood flow restoration of recanalized tibial arteries and distal tissue reperfusion (D). CE-MRA = contrast-enhanced magnetic resonance angiography, CTOs = chronic total occlusions, DSA = digital subtraction angiography

• 

  Fig. 3 Kaplan-Meier estimates for prevalence of non-restenosis (A) and limb salvage (B) and comparison between GFG and PFG. Differences between groups were compared using log-rank test. Horizontal ticks along survival curve indicate censored times. Number of patients at risk of failure or remaining in at-risk set against corresponding times is indicated in table below graph. GFG = good flow group, PFG = poor flow group

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