Predicting Major Lower Limb Amputations in Chronic Limb-Threatening Ischemia: The Role of Pedal Medial Arterial Calcification.

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Harri Gruffydd Jones, Maram Darwish, Lewis Meecham
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Abstract

Objective: The Pedal Medial Arterial Calcification (pMAC) score is a radiographic tool that quantifies arterial calcification in the foot, providing a novel approach to predict outcomes in chronic limb-threatening ischemia (CLTI). This study investigates the association of pMAC scores with clinical outcomes in patients undergoing major lower limb amputations (MLLA). Methods: This retrospective study analyzed data from the National Vascular Registry (NVR) for the Southeast Wales Vascular Network (SEWVN) from July 2022 to June 2024. Patients undergoing MLLA with available preoperative radiographs were included. pMAC scores were categorized into low (0-1), medium (2-3), and high (4-5). Cox proportional hazards regression assessed the impact of pMAC on time to amputation, while additional analyses evaluated its association with revascularization outcomes and systemic comorbidities. Results: A total of 119 patients were included after excluding cases with insufficient imaging. Higher pMAC scores were associated with male gender (P = 0.009) and chronic kidney disease (P = 0.017), though not with preoperative blood test parameters. Each unit increase in pMAC score was associated with a 22% higher risk of amputation over time (HR = 1.22, P = 0.049). Medium pMAC scores correlated with shorter time to MLLA (P = 0.0516). Revascularization type did not significantly impact time to amputation (P = 0.66). Conclusions: pMAC predicts amputation risk in CLTI patients, independent of revascularization type. Integrating pMAC into clinical workflows may refine risk stratification and guide postoperative care. Prospective validation is warranted to establish its role in vascular surgery decision-making.

预测慢性肢体缺血严重下肢截肢:脚内侧动脉钙化的作用。
目的:足部内侧动脉钙化(pMAC)评分是一种量化足部动脉钙化的放射学工具,为预测慢性肢体威胁缺血(CLTI)的预后提供了一种新的方法。本研究探讨了pMAC评分与大下肢截肢(MLLA)患者临床预后的关系。方法:本回顾性研究分析了2022年7月至2024年6月东南威尔士血管网络(SEWVN)国家血管登记处(NVR)的数据。接受MLLA的患者均有术前x线片。pMAC得分分为低(0-1)、中(2-3)和高(4-5)。Cox比例风险回归评估了pMAC对截肢时间的影响,而其他分析评估了其与血运重建结果和全身合并症的关系。结果:排除影像学不全病例后,共纳入119例。较高的pMAC评分与男性(P = 0.009)和慢性肾脏疾病(P = 0.017)相关,但与术前血液检查参数无关。随着时间的推移,pMAC评分每增加一个单位,截肢风险增加22% (HR = 1.22, P = 0.049)。中等pMAC评分与较短的MLLA时间相关(P = 0.0516)。血运重建类型对截肢时间无显著影响(P = 0.66)。结论:pMAC可预测CLTI患者的截肢风险,与血运重建类型无关。将pMAC整合到临床工作流程中可以细化风险分层并指导术后护理。前瞻性验证是必要的,以确定其在血管手术决策中的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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