A prognostic model for amputation in critical lower limb ischemia

H. M. Klomp; E. W. Steyerberg; C. H.A. Wittens; H. van Urk; J. D.F. Habbema; J. J.A.M. van den Dungen; M. J. Staal; R. J. van Det; H. E. van de Aa; E. A. Kole; F. L. Moll; A. L. Liem; H. A. van Dijk; P. J. Theuvenet; J. C. Sier; N. Lambooy; T. I. Yo; G. Kazemier; C. H.A. Wittens; N. A.J.J. duBois; A. I. Veeger; H. van Urk; J. Buth; E. C.M. Bollen; J. Lens; G. H. Spincemaille; W. Hollander; A. G.M. Hoofwijk; J. H.M. Tordoir; T. H.A. Bikkers; D. van Lent; P. J. van Elk; M. J.H.M. Jacobs; D. Th Ubbink; A. C. van der Ham

doi:https://doi.org/10.1177/1358863X08098227

A prognostic model for amputation in critical lower limb ischemia

H. M. Klomp, E. W. Steyerberg, C. H.A. Wittens, H. van Urk, J. D.F. Habbema, J. J.A.M. van den Dungen, M. J. Staal, R. J. van Det, H. E. van de Aa, E. A. Kole, F. L. Moll, A. L. Liem, H. A. van Dijk, P. J. Theuvenet, J. C. Sier, N. Lambooy, T. I. Yo, G. Kazemier, C. H.A. Wittens, N. A.J.J. duBoisA. I. Veeger, H. van Urk, J. Buth, E. C.M. Bollen, J. Lens, G. H. Spincemaille, W. Hollander, A. G.M. Hoofwijk, J. H.M. Tordoir, T. H.A. Bikkers, D. van Lent, P. J. van Elk, M. J.H.M. Jacobs, D. Th Ubbink, A. C. van der Ham

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Abstract

In a (negative) multicenter randomized trial on management for inoperable critical lower limb ischemia, comparing spinal cord stimulation and best medical treatment, a number of pre-defined factors were analyzed for prognostic value. We included a radiological arterial disease score, modified from the SVS/ISCVS runoff score. The purpose of this analysis was to evaluate clinical factors and commonly used circulatory measurements for prognostic modeling in patients with critical lower limb ischemia. We determined the incidence of amputation and its relation to various pre-defined risk factors. A total of 120 patients with critical limb ischemia were included in the study. The integrity of circulation in the affected limb was evaluated on five levels: suprainguinal, infrainguinal, popliteal, infrapopliteal and pedal. A total radiological arterial disease score was calculated from 1 (full integrity of circulation) to 20 (maximally compromised state). We used Cox regression analysis to quantify prognostic effects and differential treatment (predictive) effects. Major amputation occurred in 33% of the patients at 6 months and in 51% at 2 years. The presence of ischemic skin lesions and the radiological arterial disease score were independent prognostic factors for amputation. Patients with ulcerations or gangrene had a higher amputation risk (hazard ratio 2.38, p = 0.018 and 2.30, p = 0.036 respectively) as well as patients with a higher radiological arterial disease score (hazard ratio 1.17 per increment, p = 0.003). We did not observe significant interactions between prognostic factors and the effect of spinal cord stimulation. In conclusion, in patients with critical lower limb ischemia, the presence of ischemic skin lesions and the described radiological arterial disease score can be used to estimate amputation risk.

Original language	English
Pages (from-to)	109-115
Number of pages	7
Journal	Vascular Medicine
Volume	14
Issue number	2
DOIs	https://doi.org/10.1177/1358863X08098227
Publication status	Published - 2009

Keywords

Amputation
Peripheral arterial disease
Predictive value of tests
Prognosis
Randomized controlled trials

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https://doi.org/10.1177/1358863X08098227

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Klomp, H. M., Steyerberg, E. W., Wittens, C. H. A., van Urk, H., Habbema, J. D. F., van den Dungen, J. J. A. M., Staal, M. J., van Det, R. J., van de Aa, H. E., Kole, E. A., Moll, F. L., Liem, A. L., van Dijk, H. A., Theuvenet, P. J., Sier, J. C., Lambooy, N., Yo, T. I., Kazemier, G., Wittens, C. H. A., ... van der Ham, A. C. (2009). A prognostic model for amputation in critical lower limb ischemia. Vascular Medicine, 14(2), 109-115. https://doi.org/10.1177/1358863X08098227

@article{203cd0aa4c6941878b2a0b1476b9971e,

title = "A prognostic model for amputation in critical lower limb ischemia",

abstract = "In a (negative) multicenter randomized trial on management for inoperable critical lower limb ischemia, comparing spinal cord stimulation and best medical treatment, a number of pre-defined factors were analyzed for prognostic value. We included a radiological arterial disease score, modified from the SVS/ISCVS runoff score. The purpose of this analysis was to evaluate clinical factors and commonly used circulatory measurements for prognostic modeling in patients with critical lower limb ischemia. We determined the incidence of amputation and its relation to various pre-defined risk factors. A total of 120 patients with critical limb ischemia were included in the study. The integrity of circulation in the affected limb was evaluated on five levels: suprainguinal, infrainguinal, popliteal, infrapopliteal and pedal. A total radiological arterial disease score was calculated from 1 (full integrity of circulation) to 20 (maximally compromised state). We used Cox regression analysis to quantify prognostic effects and differential treatment (predictive) effects. Major amputation occurred in 33% of the patients at 6 months and in 51% at 2 years. The presence of ischemic skin lesions and the radiological arterial disease score were independent prognostic factors for amputation. Patients with ulcerations or gangrene had a higher amputation risk (hazard ratio 2.38, p = 0.018 and 2.30, p = 0.036 respectively) as well as patients with a higher radiological arterial disease score (hazard ratio 1.17 per increment, p = 0.003). We did not observe significant interactions between prognostic factors and the effect of spinal cord stimulation. In conclusion, in patients with critical lower limb ischemia, the presence of ischemic skin lesions and the described radiological arterial disease score can be used to estimate amputation risk.",

keywords = "Amputation, Peripheral arterial disease, Predictive value of tests, Prognosis, Randomized controlled trials",

author = "Klomp, {H. M.} and Steyerberg, {E. W.} and Wittens, {C. H.A.} and {van Urk}, H. and Habbema, {J. D.F.} and {van den Dungen}, {J. J.A.M.} and Staal, {M. J.} and {van Det}, {R. J.} and {van de Aa}, {H. E.} and Kole, {E. A.} and Moll, {F. L.} and Liem, {A. L.} and {van Dijk}, {H. A.} and Theuvenet, {P. J.} and Sier, {J. C.} and N. Lambooy and Yo, {T. I.} and G. Kazemier and Wittens, {C. H.A.} and duBois, {N. A.J.J.} and Veeger, {A. I.} and {van Urk}, H. and J. Buth and Bollen, {E. C.M.} and J. Lens and Spincemaille, {G. H.} and W. Hollander and Hoofwijk, {A. G.M.} and Tordoir, {J. H.M.} and Bikkers, {T. H.A.} and {van Lent}, D. and {van Elk}, {P. J.} and Jacobs, {M. J.H.M.} and Ubbink, {D. Th} and {van der Ham}, {A. C.}",

year = "2009",

doi = "https://doi.org/10.1177/1358863X08098227",

language = "English",

volume = "14",

pages = "109--115",

journal = "Vascular Medicine",

issn = "1358-863X",

publisher = "SAGE Publications Ltd",

number = "2",

}

Klomp, HM, Steyerberg, EW, Wittens, CHA, van Urk, H, Habbema, JDF, van den Dungen, JJAM, Staal, MJ, van Det, RJ, van de Aa, HE, Kole, EA, Moll, FL, Liem, AL, van Dijk, HA, Theuvenet, PJ, Sier, JC, Lambooy, N, Yo, TI, Kazemier, G, Wittens, CHA, duBois, NAJJ, Veeger, AI, van Urk, H, Buth, J, Bollen, ECM, Lens, J, Spincemaille, GH, Hollander, W, Hoofwijk, AGM, Tordoir, JHM, Bikkers, THA, van Lent, D, van Elk, PJ, Jacobs, MJHM, Ubbink, DT & van der Ham, AC 2009, 'A prognostic model for amputation in critical lower limb ischemia', Vascular Medicine, vol. 14, no. 2, pp. 109-115. https://doi.org/10.1177/1358863X08098227

TY - JOUR

T1 - A prognostic model for amputation in critical lower limb ischemia

AU - Klomp, H. M.

AU - Steyerberg, E. W.

AU - Wittens, C. H.A.

AU - van Urk, H.

AU - Habbema, J. D.F.

AU - van den Dungen, J. J.A.M.

AU - Staal, M. J.

AU - van Det, R. J.

AU - van de Aa, H. E.

AU - Kole, E. A.

AU - Moll, F. L.

AU - Liem, A. L.

AU - van Dijk, H. A.

AU - Theuvenet, P. J.

AU - Sier, J. C.

AU - Lambooy, N.

AU - Yo, T. I.

AU - Kazemier, G.

AU - Wittens, C. H.A.

AU - duBois, N. A.J.J.

AU - Veeger, A. I.

AU - van Urk, H.

AU - Buth, J.

AU - Bollen, E. C.M.

AU - Lens, J.

AU - Spincemaille, G. H.

AU - Hollander, W.

AU - Hoofwijk, A. G.M.

AU - Tordoir, J. H.M.

AU - Bikkers, T. H.A.

AU - van Lent, D.

AU - van Elk, P. J.

AU - Jacobs, M. J.H.M.

AU - Ubbink, D. Th

AU - van der Ham, A. C.

PY - 2009

Y1 - 2009

N2 - In a (negative) multicenter randomized trial on management for inoperable critical lower limb ischemia, comparing spinal cord stimulation and best medical treatment, a number of pre-defined factors were analyzed for prognostic value. We included a radiological arterial disease score, modified from the SVS/ISCVS runoff score. The purpose of this analysis was to evaluate clinical factors and commonly used circulatory measurements for prognostic modeling in patients with critical lower limb ischemia. We determined the incidence of amputation and its relation to various pre-defined risk factors. A total of 120 patients with critical limb ischemia were included in the study. The integrity of circulation in the affected limb was evaluated on five levels: suprainguinal, infrainguinal, popliteal, infrapopliteal and pedal. A total radiological arterial disease score was calculated from 1 (full integrity of circulation) to 20 (maximally compromised state). We used Cox regression analysis to quantify prognostic effects and differential treatment (predictive) effects. Major amputation occurred in 33% of the patients at 6 months and in 51% at 2 years. The presence of ischemic skin lesions and the radiological arterial disease score were independent prognostic factors for amputation. Patients with ulcerations or gangrene had a higher amputation risk (hazard ratio 2.38, p = 0.018 and 2.30, p = 0.036 respectively) as well as patients with a higher radiological arterial disease score (hazard ratio 1.17 per increment, p = 0.003). We did not observe significant interactions between prognostic factors and the effect of spinal cord stimulation. In conclusion, in patients with critical lower limb ischemia, the presence of ischemic skin lesions and the described radiological arterial disease score can be used to estimate amputation risk.

AB - In a (negative) multicenter randomized trial on management for inoperable critical lower limb ischemia, comparing spinal cord stimulation and best medical treatment, a number of pre-defined factors were analyzed for prognostic value. We included a radiological arterial disease score, modified from the SVS/ISCVS runoff score. The purpose of this analysis was to evaluate clinical factors and commonly used circulatory measurements for prognostic modeling in patients with critical lower limb ischemia. We determined the incidence of amputation and its relation to various pre-defined risk factors. A total of 120 patients with critical limb ischemia were included in the study. The integrity of circulation in the affected limb was evaluated on five levels: suprainguinal, infrainguinal, popliteal, infrapopliteal and pedal. A total radiological arterial disease score was calculated from 1 (full integrity of circulation) to 20 (maximally compromised state). We used Cox regression analysis to quantify prognostic effects and differential treatment (predictive) effects. Major amputation occurred in 33% of the patients at 6 months and in 51% at 2 years. The presence of ischemic skin lesions and the radiological arterial disease score were independent prognostic factors for amputation. Patients with ulcerations or gangrene had a higher amputation risk (hazard ratio 2.38, p = 0.018 and 2.30, p = 0.036 respectively) as well as patients with a higher radiological arterial disease score (hazard ratio 1.17 per increment, p = 0.003). We did not observe significant interactions between prognostic factors and the effect of spinal cord stimulation. In conclusion, in patients with critical lower limb ischemia, the presence of ischemic skin lesions and the described radiological arterial disease score can be used to estimate amputation risk.

KW - Amputation

KW - Peripheral arterial disease

KW - Predictive value of tests

KW - Prognosis

KW - Randomized controlled trials

UR - http://www.scopus.com/inward/record.url?scp=65349120795&partnerID=8YFLogxK

U2 - https://doi.org/10.1177/1358863X08098227

DO - https://doi.org/10.1177/1358863X08098227

M3 - Article

C2 - 19366816

SN - 1358-863X

VL - 14

SP - 109

EP - 115

JO - Vascular Medicine

JF - Vascular Medicine

IS - 2

ER -

A prognostic model for amputation in critical lower limb ischemia

Abstract

Keywords

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