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Salaun P, Desormais I, Lapébie FX, Rivière AB, Aboyans V, Lacroix P, Bataille V, Constans J, Boulon C, et al.
Angiology. Date of publication 2019 Mar 1;volume 70(3):229-236.
1. Angiology. 2019 Mar;70(3):229-236. doi: 10.1177/0003319718793566. Epub 2018 Aug 16. Comparison of Ankle Pressure, Systolic Toe Pressure, and Transcutaneous Oxygen Pressure to Predict Major Amputation After 1 Year in the COPART Cohort. Salaun P(1), Desormais I(2), Lapébie FX(3), Rivière AB(3), Aboyans V(4), Lacroix P(2), Bataille V(5)(6), Constans J(1), Boulon C(1). Author information: (1)Médecine vasculaire, Hôpital St Andre, Bordeaux, France. (2)Médecine vasculaire, Hôpital Dupuytren, Limoges, France. (3)Service de Médecine Vasculaire, CHU Toulouse, TSA, Toulouse, France. (4)Service de Cardiologie, Hôpital Universitaire Dupuytren, CHU de Limoges, Imoges, France. (5)Stroma Lab UMR 5273/INSERM U1031, Toulouse, France. (6)Université de Toulouse III, Toulouse, France. The hemodynamic definition of critical limb ischemia (CLI) has evolved over time but remains controversial. We compared the prediction of major amputation by 3 hemodynamic methods. Patients were selected from the Cohorte des Patients ARTériopathes cohort of patients hospitalized for peripheral arterial disease. Patients with CLI were enrolled according to the Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease II definition and followed up for at least 1 year. We compared the major amputation rate according to initial ankle pressure (AP), systolic toe pressure (STP), and forefoot transcutaneous oxygen pressure (TcPO2); 556 patients were included and divided into surgical (264) and medical (292) groups. The AP failed to identify 42% of patients with CLI. After 1 year, 27% of medical and 17% of surgical patients had undergone major amputation. The TP <30 mm Hg predicted major amputation in the whole sample and in the medical group (odds ratio [OR] 3.5 [1.7-7.1] and OR 5 [2-12.4], respectively), but AP did not. The TcPO2 <10 mm Hg also predicted major amputation (OR 2.3 [1.5-3.5] and OR 3.8 [2.1-6.8]). The best predictive thresholds to predict major amputation were STP <30 mm Hg and TcPO2 <10 mm Hg. None of these methods performed before surgery was able to predict outcome in the revascularized patients. DOI: 10.1177/0003319718793566 PMID: 30114947 [Indexed for MEDLINE]
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Arterial Ulcer - Introduction and Assessment