Association of Ankle-Brachial Indices With Limb Revascularization or Amputation in Patients With Peripheral Artery Disease

Abstract

Key Points Question Are ankle-brachial indices associated with limb outcomes in community-dwelling patients with peripheral artery disease as identified by computational approaches applied to electronic health records? Findings In this cohort study of 1413 community-dwelling patients, peripheral artery disease was identified and limb outcomes were retrieved by computational approaches applied to electronic health records. Ankle-brachial indices of 1.4 or greater were associated with limb amputation and ankle-brachial indices less than 0.5 were associated with limb revascularization. Meaning Severe disease and poorly compressible arteries detected by ankle-brachial indices were associated with adverse outcomes in community-dwelling patients with peripheral artery disease; ascertainment of peripheral artery disease phenotypes and outcomes by computational approaches applied to electronic health records is feasible.

Association of infrapopliteal medial arterial calcification with lower-limb amputations in high-risk patients: A systematic review and meta-analysis

“…The influence analysis showed that only one study had a significantly heavier weight than others; 37 however, the overall association between MAC and risk of LLA did not significantly change when removing it by the final computation, as well as removing each of the other studies, thus suggesting a good consistency for our final results. Moreover, our sensitivity analysis showed that the pooled estimate was not significantly affected by lower quality studies.…”

“…Among these, 37 articles were excluded (27% of fully reviewed papers were excluded because they did not study amputations as an outcome; Figure 1). Finally, 15 articles were selected for inclusion in the meta-analysis; 24–38 their main characteristics are reported in online supplemental Table II.…”

“…The majority of studies were from European (six studies) 25,27,30,31,35,38 and North American (six studies) 24,26,28,34,36,37 populations, followed by Asian population (two studies), 32,33 while one study was multicentric (Germany, USA, and Tanzania). 29…”

A Novel Scoring System for Small Artery Disease and Medial Arterial Calcification Is Strongly Associated With Major Adverse Limb Events in Patients With Chronic Limb-Threatening Ischemia

“…Previous authors have shown the histopathological findings of extensive MAC in amputated limbs 19–22 and the association of MAC with ulcer, gangrene, and amputation. 23–26,30–32…”

“…27 Moreover, an elevated ankle-brachial index (ABI), considered an expression of noncompressible ankle arteries as a consequence of MAC, is associated with a high prevalence of occlusive tibial and pedal arch disease 28 and occlusive PAD 29 and is as equally prognostic in predicting the need for amputation as a low ABI. 30–32…”