Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease

Wickström, Jan-Erik; Laivuori, Mirjami; Aro, Ellinoora; Sund, Reijo; Hautero, O.; Venermo, Maarit

doi:10.1016/j.ejvs.2017.02.012

Cited by 33 publications

(37 citation statements)

References 32 publications

(31 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Wickström et al found more than a 2-fold increase in amputation risk for STP <30 mm Hg, and others found that low toe pulse wave amplitude was also a predictor of amputation. 18,19 Wickström et al found by multivariate analysis that STP <30 mm Hg but not AP predicted poor local or general prognosis in PAD.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Ankle Pressure, Systolic Toe Pressure, and Transcutaneous Oxygen Pressure to Predict Major Amputation After 1 Year in the COPART Cohort

et al. 2018

View full text Add to dashboard Cite

The hemodynamic definition of critical limb ischemia (CLI) has evolved over time but remains controversial. We compared the prediction of major amputation by 3 hemodynamic methods. Patients were selected from the Cohorte des Patients ARTériopathes cohort of patients hospitalized for peripheral arterial disease. Patients with CLI were enrolled according to the Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease II definition and followed up for at least 1 year. We compared the major amputation rate according to initial ankle pressure (AP), systolic toe pressure (STP), and forefoot transcutaneous oxygen pressure (TcPO); 556 patients were included and divided into surgical (264) and medical (292) groups. The AP failed to identify 42% of patients with CLI. After 1 year, 27% of medical and 17% of surgical patients had undergone major amputation. The TP <30 mm Hg predicted major amputation in the whole sample and in the medical group (odds ratio [OR] 3.5 [1.7-7.1] and OR 5 [2-12.4], respectively), but AP did not. The TcPO <10 mm Hg also predicted major amputation (OR 2.3 [1.5-3.5] and OR 3.8 [2.1-6.8]). The best predictive thresholds to predict major amputation were STP <30 mm Hg and TcPO <10 mm Hg. None of these methods performed before surgery was able to predict outcome in the revascularized patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of Ankle Pressure, Systolic Toe Pressure, and Transcutaneous Oxygen Pressure to Predict Major Amputation After 1 Year in the COPART Cohort

et al. 2018

View full text Add to dashboard Cite

show abstract

“…A limitation of this work was that studies reviewed lacked standardised criteria for reporting PAD severity, so ABI levels and Fontaine scores were used to differentiate less severe PAD from more severe PAD. Recent research suggests that toe pressures <30 mmHg or toe/brachial systolic blood pressure ratio <0.25 may predict 36‐month amputation or mortality, offering support to inform clinical decisions regarding conservative and/or invasive practice. Many clinicians believe that even with ABI < 0.9 and symptomatic IC, one should not operate on a patient who can walk at least two blocks.…”

Section: Discussionmentioning

confidence: 99%

Peripheral arterial disease: Scoping review of patient‐centred outcomes

Bolton

2019

International Wound Journal

View full text Add to dashboard Cite

Peripheral arterial disease (PAD) impairs patients' quality of life (QOL), walking and ulcer healing, increasing patient pain, costs, and risks of amputation or mortality. A literature appraisal described PAD treatment capacity to improve validated patient-centred outcomes in controlled clinical studies. The PUBMED database was searched from 1 January 1970 to 21 June 2018, for original and derivative controlled clinical trial references addressing MeSH terms for 'ischemia' AND 'leg ulcer'. Non-ischemic ulcer treatment references were excluded. Frequencies of improved (P < .05) outcomes were reported. Eighty-eight studies on 4153 patients were summarized. Walking, pain or QOL improved mainly for interventions administered before PAD became severe. Amputation incidence, pain and ulcer healing were more frequently reported in those with severe PAD. Independent of PAD severity, patients experienced more likely improved walking, QOL, or pain reduction in response to structured walking interventions or those increasing calf muscle activity. Those with more severe PAD were more likely to report amputation reduction, mainly in response to invasive interventions. Those with PAD experienced more consistently improved patient-centred outcomes if they received multidisciplinary PAD management with supervised walking or calf muscle activity, with more likely amputation risk reduced for those with more severe PAD. Key Messages• Peripheral arterial disease (PAD) progresses in severity from impaired walking and quality of life (QOL) through increasing likelihood of pain, ulceration, gangrene, amputation, or death and magnifies clinical, economic, and patient burdens of venous insufficiency or diabetes • improving PAD-related patient-centred outcomes requires consistent early, effective PAD diagnosis and effective treatment to improve lower limb perfusionAbbreviations: ABI, ankle-to-brachial systolic blood pressure index (ratio), optimally performed using handheld Doppler ultrasound; ALU, arterial leg ulcers; CLI, critical limb ischaemia; DAPT, dual antiplatelet therapy, for example, aspirin plus low molecular weight heparin; DFU, diabetic foot ulcers; ER, endovascular revascularisation; HBO, hyperbaric oxygen; IC, intermittent claudication; IPC, intermittent pneumatic compression of the calf muscle; MLU, mixed aetiology leg ulcers complicated with peripheral arterial disease; NMES, neuromuscular electrical stimulation sufficient to cause contraction of the calf muscle; PAD, peripheral arterial disease; PPG, photoplethysmography a technique for measuring venous emptying; QOL, quality of life; RCT, randomised clinical trial; SET, structured exercise therapy supervised by a professional; SOC, standard of care; TcPO 2 , transcutaneous partial pressure of oxygen; VLU, venous leg ulcer.

show abstract

“…In patients with peripheral arterial occlusive disease, low toe pressures reflecting impaired peripheral circulation have been found to predict overall and cardiovascular mortality. 6 Furthermore, an association between a decreased ankle-brachial index and mortality was also described in HD patients. 7 Several case series in HD populations suggested that patients with hand ischemia had a poor survival.…”

Section: Introductionmentioning

confidence: 95%

Severe hemodialysis access-induced distal ischemia may be associated with poor survival

et al. 2020

View full text Add to dashboard Cite

Background: Some hemodialysis patients develop hemodialysis access-induced distal ischemia due to insufficient loco-regional perfusion pressure and consequent poor arterial flow. We hypothesized that patients with severe hemodialysis access-induced distal ischemia had worse survival compared with patients with mild or no hemodialysis access-induced distal ischemia. Methods: This single-center retrospective observational cohort study included three groups of prevalent hemodialysis patients with an upper extremity vascular access between 2006 and 2018. Symptomatic patients had signs and symptoms of hemodialysis access-induced distal ischemia and low digital brachial indices (<60%) and were divided into a mild (Grade I–IIa) and a severe hemodialysis access-induced distal ischemia (IIb–IV) group. The control group consisted of hemodialysis patients without signs of hemodialysis access-induced distal ischemia with digital brachial indices ≥60%. Factors potentially related to 4-year survival were analyzed. Results: Mild hemodialysis access-induced distal ischemia-patients displayed higher digital brachial indices ( n = 23, 41%, ±3) compared with severe hemodialysis access-induced distal ischemia-patients ( n = 28, 24%, ±4), whereas controls had the highest values ( n = 48, 80%, ±2; p < .001). A total of 44 patients (44%) died during follow-up. Digital brachial index (hazards ratio 0.989 [0.979–1.000] p = .046) was related to overall mortality following correction for presence of arterial occlusive disease (hazards ratio 2.28 [1.22–4.29], diabetes (hazards ratio 2.00 [1.07–3.72], and increasing age (hazards ratio 1.03 [1.01–1.06] as was digital pressure (hazards ratio 0.990 [0.983–0.998], p = .011). Overall survival was similar in mild hemodialysis access-induced distal ischemia and controls (2-year, 79% ±5; 4-year, 57% ±6, p = .818). In contrast, 4-year survival was >20% lower in patients with severe hemodialysis access-induced distal ischemia (2-year 62%± 10; 4-year 34% ± 10; p = .026). Conclusion: Presence of severe hemodialysis access-induced distal ischemia may be associated with poorer survival in hemodialysis patients. Lower digital brachial index values are associated with higher overall mortality, even following correction for other known risk factors.

show abstract

Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease

Cited by 33 publications

References 32 publications

Comparison of Ankle Pressure, Systolic Toe Pressure, and Transcutaneous Oxygen Pressure to Predict Major Amputation After 1 Year in the COPART Cohort

Comparison of Ankle Pressure, Systolic Toe Pressure, and Transcutaneous Oxygen Pressure to Predict Major Amputation After 1 Year in the COPART Cohort

Peripheral arterial disease: Scoping review of patient‐centred outcomes

Severe hemodialysis access-induced distal ischemia may be associated with poor survival

Contact Info

Product

Resources

About