The “Renal Foot”: Angiographic patterns that dramatically increase challenges of limb preservation #DiabeticFoot #ActAgainstAmputation @KeckMedUSC

This study published from our SALSA #ToeFlowandGo group.

Highlights

CLTI patients had more extensive and severe disease in the infrapopliteal arteries compared to arteries above the knee.

Patients with CLTI and ESRD had more severe disease in the arteries supplying flow to the plantar foot.

ESRD patients exhibit a pattern of arterial disease, we termed the“renal foot,” that frequently involves the posterior tibial and lateral plantar arteries.

If validated, this data can provide valuable information for clinicians attempting to formulate optimal revascularization strategies in ESRD patients with CLTI

Patrick A.Baghdasaryan, Jun Ho Bae, WendyYu, Vincent Rowe, David G. Armstrong, David M.Shavelle, Leonardo C.Clavijoa lclavijo@ usc.edu

Background

Patients with chronic limb threatening ischemia (CLTI) and end-stage renal disease (ESRD) have greater risk of limb loss compared to those with CLTI alone. We investigated angiographic patterns in patients with CLTI and evaluated for differences based on ESRD status.

Methods.

We reviewed lower extremity angiograms of 152 CLTI patients at a single academic medical center from 2011 to 2017 and analyzed them based on the Graziani and Bollinger classification systems. We used these classification systems to evauate for angiographic patterns and arterial disease severity categorized by the presence or absence of ESRD.

Results

The analysis included 152 CLTI patients (161 angiograms). Patients’ mean age was 63.4 ± 11.3 years and 20 (12.4%) patients had ESRD. In our study population, infrapopliteal arterial disease was more severe than femoropopliteal disease. Disease of the arteries providing direct flow to the plantar arch was more severe in ESRD patients compared to non-ESRD patients, evident by higher Graziani Class VII disease (20% vs. 4.9%, p = .03). ESRD patients also had higher rates of concurrent significant stenosis of the posterior tibial and lateral plantar arteries (70% vs. 23%, p < .0001).

Conclusion

In people with CLTI, infrapopliteal arteries are more severely affected than proximal femoropopliteal arteries. ESRD patients exhibit a pattern of arterial disease, we termed the “renal foot,” that frequently involves arteries providing direct flow to the plantar arch.

Keywords

Chronic limb threatening ischemiaCritical limb ischemiaEnd stage renal diseasePeripheral artery diseaseAmputation

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