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smoking, ABI <0.7 or >1.4, non-Caucasian race, and Hispanic ethnicity were associated with increased reamputation (Table ). The TMA progression model was created from the aforementioned variables, with five risk group categories created based on quintile distribution of summed amputation progression scores (1 [lowest risk; score <0], 2 [score 0-1], 3 [score 2], 4 [score 3-4], 5 [highest risk; score >4]). The model displayed good fit with bootstrap validated area under the curve of 0.67 (95% confidence interval, 0.61-0.72) and appropriate Hosmer-Lemeshow goodness of fit testing with a P value of .88. As expected, Kaplan-Meier analysis for reamputation showed corresponding increasing 1 -year reamputation rates based on risk quintile (1 ¼ 9.3%, 2 ¼ 16.0%, 3 ¼ 20.1%, 4 ¼ 36.4%, 5 ¼ 42.7%; P < .001) (Figure ).Conclusions: Using six readily obtained preoperative variables (indication for amputation, ambulatory status, smoking status, ABI, race, ethnicity), we created the TMA progression model which accurately predicts 1-year reamputation rates at a higher level. This model can be utilized by physicians in determining the appropriate level of initial amputation in patients presenting with foot and toe wounds without options for revascularization.

with men. Gender-specific consideration might be required in patients undergoing lower extremity revascularization. A higher treatment threshold may be warranted in considering intervening on women with symptomatic peripheral arterial disease owing to the increased risks of postprocedural mortality and complications.

was deployed. Left ventricular function and aortic valve integrity were assessed in all animals through left ventricular angiography, at necropsy, and three were selected for dynamic intracardiac echocardiography during the entire procedure.Results: Transapical deployment of the branched endograft was successful in all animals (six of six). One pig developed ventricular fibrillation before side-branch cannulation and was euthanized. Antegrade brachiocephalic trunk cannulation was successful in the remaining five animals. Mean blood pressure decreased from 41.8 6 9.4 to 38.7 6 9.6 mm Hg (P < .001) with sheath crossing of the aortic valve and returned to baseline following sheath removal (40.4 6 16 mm Hg). Mean heart rate rose throughout the procedure from 67 6 13 to 95 6 36 (P < .001) and remained elevated at completion of the experiment. Intracardiac echocardiography demonstrated no abnormalities in cardiac function before or after implantation in the surviving five animals and mild to moderate aortic regurgitation with sheath crossing that returned to baseline after sheath removal. Ventricular closure was hemostatic in five of five pigs, and postoperative necropsy demonstrated no gross damage to the aortic valve, myocardium, or aorta in any of the six animals.Conclusions: Transapical branched endograft delivery with antegrade branch cannulation is feasible, is well tolerated, and does not significantly influence hemodynamic or cardiac parameters in an animal model.

Objective: Chronic limb-threatening ischemia (CLTI) is a severe manifestation of peripheral artery disease (PAD) with high morbidity for aging populations. Although the metabolites produced by the intestinal microbiota have been shown to predict the long-term risk of adverse events in patients with PAD, the contribution of the blood microbiota to CLTI development has not been investigated. We profiled the blood microbiota of patients with PAD and CLTI compared with those with PAD and intermittent claudication (CLAUD) to identify any differences in microbial composition.Methods: Blood samples were collected from patients aged 49 to 84 years with CLAUD (n ¼ 15) or CLTI (n ¼ 4), which had been defined by clinical symptoms and the ankle-brachial or toe-brachial index. The ethics board approved the study. The blood microbiota of the CLAUD and CLTI groups was profiled using 16S rDNA sequencing and QIIME 2 analysis (available at: https://qiime2.org/). Sequences were rarefied to 7962 reads/ sample for Shannon diversity and principal coordinates analyses (weighted UniFrac with PERMANOVA). A multivariate linear regression model was generated using the gneiss software package to identify differentially abundant bacterial genera between the CLAUD and CLTI patients.Results: No differences in broad microbial diversity were identified with Shannon diversity or principal coordinates analyses. PAD status accounted for 5.7% of the variation in a linear regression model predicting microbiota composition. A cluster of nine operational taxonomic units, including the pathogenic bacterium Acidovorax, were differentially abundant between the CLAUD and CLTI groups (P ¼ .015; Fig). Conclusion:The progression of PAD from CLAUD to CLTI is associated with altered blood microbiota composition. Although several differentially abundant bacteria, including Stenotrophomonas and Acidovorax, have been previously identified as laboratory contaminants, Acidovorax spp. have also been detected in situ in symptomatic atherosclerotic plaques. These findings warrant further investigation of differentially abundant bacteria as prospective biomarkers for CLTI development in those with PAD. Future studies could explore the blood microbiota as a causative agent and potential therapeutic target for PAD.