Wifi classification does not predict limb amputation risk in dialysis patients following critical limb ischemia revascularization
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1 Wifi classification does not predict limb amputation risk in dialysis patients following critical limb ischemia revascularization A Sonetto, M Abualhin, M Gargiulo, GL Faggioli, A Stella
2 Disclosure Speaker name: Alessia Sonetto I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) X I do not have any potential conflict of interest
3 Background The Society for Vascular Surgery's (WIfI) classification: -Wound (0-3) -Ischemia (0-3) -foot Infection (0-3) Predicts amputation risk and revascularization benefit in patients affected by Critical Limb Ischemia(CLI). *Mills et al, J.Vasc Surg. 2014
4 Purpose of study To verify the capacity of WIfI classification to predict limb amputation risk in dialysis patients treated for CLI by any revascularization technique.
5 Methods January-2011 to December-2015 Retrospective study of prospectively maintained data base. Inclusion criteria: Dialysis patients with CLI (Rutherford 4-6) Treated by any type of revascularization (Surgical, Endovascular or Hybrid) Presence of complete data about wound characteristics, ischemia degree and extent of foot infection Patient's demographics and characteristics were assessed. Arterial disease extension was evaluated on available angiograms, CT-Angio and Duplex reports. Statistics: Descriptive, frequency statistics were used for population characteristics. Kaplan-Meier analysis with Log-Rank test was performed to compare LS between risk stages. Cox regression Univariate and Multivariate analyses were used to define risk factors.
6 Methods Limbs were stratified according to WIfI clinical stage *Mills et al, J.Vasc Surg. 2014
7 Methods Endpoints: Primary endpoint: WIfI classification capability to differentiate very low and high limb amputation risk at 12 months. Secondary endpoints: Limb Salvage (LS) Primary (PP), Assisted (AP) and Secondary Patency (SP) Patient Survival (S) Risk factors for LS
8 Results Limbs 142 Patients 108 Bilateral disease 31.5% Male 77.8% Age 71.4 ± 8.8 yrs Comorbidities (%) Coronary artery disease 60.2 Hypertension 85.4 Diabetes mellitus 56.6 Dyslipidemia 43.5 COPD 26.5 Active smoker 6.6 ASA
9 Results Arterial disease distribution % Superficial femoral artery 65.2 Popliteal artery 45.4 Tibial arteries 95 WIfI Clinical stage distribution % , ,9 9,2
10 Results Revascularization type 9% 21% Surgical Endovascular 70% Hybrid Technical success was 93.6% 100% 80% 60% 40% 20% 0% Revascularization type and WIfI clinical stage 15,4 12,9 32,1 22,9 Hybrid 84,6 64,553,6 74,2 Surgical Endovascular
11 Results Mean follow-up 15.7 months Limb salvage Patient survival Primary patency Secondary patency 12-month 84.2% 53.3% 68.2% 86.9% 24-month 82.4% 29.6% 58.6% 83.9% WIfI clinical stage effect at 12-month Limb salvage Patient survival Primary patency Secondary patency Stage % 61.5% 77.8% 88.9% Stage % 45.8% 65.8% 86.6%
12 Results At 12 months there was no significant difference between very low and high risk WIfI stages in terms of Limb Salvage There was no significant global difference between WIfI stages in terms of Limb Salvage (Log-Rank P=0.49). Even at 1-month and 24-month evaluation no significant difference between very low and high risk WIfI stages.
13 Results Risk factors for Limb salvage: Univariate analyses: Multivariate analyses: Negative predictors wound extension P=0.015 popliteal artery disease P=0.047 Negative predictor wound extension confirmed (P=0.003,HR=2.3) Protective factors arterial hypertension P=0.048 primary and assisted patency (P <0.001 and <0.001 respectively) Protective factor primary patency confirmed (P=0.002,HR=8.7)
14 Conclusions WIfI classification could not predict limb amputation risk in dialysis patients with CLI who underwent revascularization. Dialysis patients present very poor survival. A specific predictive model that considers patient survival and revascularization status is needed in this subgroup of patients.
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16 Wifi classification does not predict limb amputation risk in dialysis patients following critical limb ischemia revascularization A Sonetto, M Abualhin, M Gargiulo, GL Faggioli, A Stella
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