title: Predictors of adverse clinical outcomes after successful infrapopliteal intervention.
abstract: OBJECTIVE
  To clarify the clinical and angiographical variables related to delayed wound healing, major amputation and death after successful infrapopliteal intervention in critical limb ischemia patients with tissue loss.
  
  
  BACKGROUND
  There is an underappreciation of adverse clinical outcomes after successful infrapopliteal intervention.
  
  
  METHODS
  Stent-assisted infrapopliteal angioplasty was successful in 106 limbs in 85 patients. Successful intervention was defined as revascularization of at least one straight-line flow to the foot.
  
  
  RESULTS
  At 6 months and 1, 2, and 5 years, the repeat intervention-free rates were 55.0, 49.6, 44.4, and 36.1%, respectively; the amputation-free survival rates were 85.7, 68.0, 54.5, and 39.8%, respectively; and the limb salvage rates were 96.0, 92.4, 86.3, and 86.3%, respectively. An infectious wound was an independent predictor of major amputation after successful intervention. The complete wound healing rates were 36.8, 57.5, 67.9, and 73.6% at 3, 6, 9, and 12 months, respectively. In stepwise multivariate Cox analysis, diabetes mellitus, an infectious wound, and the pedal arch classification were identified as independent predictors of wound healing. The long-term survival rates at 6 months and 1, 2, and 5 years were 89.5, 73.8, 62.0, and 43.4%, respectively. Stepwise multivariate Cox analysis indentified end-stage renal disease (ESRD) on hemodialysis to be an independent predictor of death.
  
  
  CONCLUSIONS
  An infectious wound, comorbidities of diabetes mellitus and ESRD on hemodialysis and classification of pedal arch can be predictors of adverse clinical outcomes after successful infrapopliteal intervention.
authors.affiliation: Department of Cardiovascular Medicine, Nishinokyo Hospital, Nara-City, Japan. kawarada90@hotmail.com
authors.forename: Osami
authors.initials: O
authors.lastname: Kawarada
authors.forename: Masahiko
authors.initials: M
authors.lastname: Fujihara
authors.forename: Akihiro
authors.initials: A
authors.lastname: Higashimori
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yokoi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Honda
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fitzgerald
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D015897:Comorbidity; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000503:physiopathology; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D014946:Wound Infection / Q000401:mortality / Q000628:therapy