Saranya Sundaram, Christian Barksdale, Stephanie Rodriguez, Mathew D Wooster
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引用次数: 0
Abstract
Background: In 2021, Ferraresi et al. created a novel scoring system based on the impact of small artery disease (SAD) and medial arterial calcification (MAC) on wound healing. SAD and MAC scores functioned similar to Wound, Ischemia, and foot Infection (WIfI) but with minimal resource expenditure. Despite its potential, few studies have expanded on the original dataset. We aim to validate SAD's impact and MAC's impact on wound healing outcomes and determine their utility in relation to current predictive models.
Methods: Single-institution retrospective review was used to identify amputations for chronic (>1 month) podiatric wounds between 2015 and 2020. Foot X-ray (MAC) or angiography (SAD) < 6 months of index procedure was required. Primary outcomes included major amputation, wound healing, major adverse limb events, and amputation-free survival (AFS). Statistical analysis included chi-squared, 1-way analysis of variance, nonparametric correlation, Kaplan-Meier, Cox regression, and Akaike/Bayesian Inclusion Criteria model comparison.
Results: Of 136 limbs, 67 received SAD scores (0-2) and 128 received MAC scores (0-2). SAD cohorts exhibited similar comorbidity profiles with exception of coronary disease, heart failure, and chronic kidney disease. MAC cohorts were notably disparate in prevalence of multiple conditions. High mean SAD/MAC scores were seen in severe (3-vessel) below-ankle disease (P = 0.001∗ [SAD], P = 0.041∗ [MAC]). Both SAD and MAC correlated with lower mean toe pressure (P = 0.043∗ [SAD], P ≤ 0.001∗ [MAC]), while only MAC correlated with higher overall WIfI score (P = 0.029∗). No significant procedural differences were noted. However, higher readmission rates (73.9% [2] vs. 46.9% [0], P = 0.014∗) and all-cause mortality (65.2% [2] vs. 26.0% [0], P = 0.002∗) were noted with higher MAC. Survival analysis revealed higher 1-year major amputation rates (P = 0.036∗), impaired wound healing (P < 0.001∗), and lower AFS (P = 0.001∗) with increasing MAC severity. Additionally, MAC-2 patients underwent amputation at faster rates than MAC-0 patients (hazard ratio 5.25, 95% confidence interval [1.82, 9.77]) with longer times to wound healing (hazard ratio 0.21, 95% confidence interval [0.08, 0.53]). Model comparison suggested a combination of WIfI and MAC could improve accuracy of predicted time to major amputation, wound healing, and AFS.
Conclusions: MAC scoring showed significant promise both as individual predictor and adjunct to current predictive models of long-term wound healing outcomes. Routine use of MAC scoring in chronic limb-threatening ischemia evaluation, especially when noninvasive testing is unavailable, could promote timely referral for intervention and efficient resource utilization in limited-resource or critical care settings. Furthermore investigation is necessary to determine MAC's impact on revascularization and how scoring can be used to guide surgical decision-making.
期刊介绍:
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence