title: Runoff detected by magnetic resonance angiography as an indicator for better recanalization outcomes in below-the-knee chronic total occlusions in diabetic patients.
abstract: OBJECTIVE
  To compare the feasibility and efficacy of recanalizing below-the-knee (BTK) chronic total occlusions (CTOs) between patients with good or poor distal runoff based on magnetic resonance angiography (MRA) scans.
  
  
  METHODS
  Two hundred long-segment BTK CTOs in 171 limbs of 113 diabetic patients (58 men; mean age 69.8±1.9 years) were divided into good distal runoff (GDR: 119 lesions, 98 limbs) or poor distal runoff groups (PDR: 81 lesions, 73 limbs) based on baseline MRA findings. After angioplasty, modified thrombolysis in myocardial ischemia (mTIMI) grades and ankle-brachial index (ABI) were used to assess immediate outcomes. Regularly scheduled duplex or MRA imaging was performed in follow-up. The restenosis and limb salvage rates were compared.
  
  
  RESULTS
  The success rates were 93.3% and 87.7% in the GDR and PDR groups, respectively (p=0.21); subintimal angioplasty was more common in the PDR group (93.0% vs. 63.1%, p<0.01). Completion angiography indicated an mTIMI grade 3 blood flow in 71.2% lesions in the GDR patients and in 52.1% in the PDR (p=0.01) group. Improvement in the ABI was greater in the GDR limbs (p<0.001 vs. PDR). Mean imaging follow-up was 10.8±6.9 months in the GDR group and 11.1±6.6 months in the PDR group. Kaplan-Meier analysis showed a better restenosis-free rate in the GDR group (80.6% vs. 61.7%; p=0.02) at 12 months and for lesions with mTIMI grade 3 flow (p<0.01). At 24 months, Kaplan-Meier analysis revealed a better limb salvage rate in the GDR group (84.2% vs. 54.6%; p=0.02).
  
  
  CONCLUSIONS
  Distal runoff detected using MRA could be a predictor for successful intraluminal recanalization, better distal tissue perfusion, improved long-term patency, and better limb salvage for patients with BTK CTOs.
authors: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Yue-Qi
authors: YQ
authors: Zhu
authors: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Jue
authors: J
authors: Wang
authors: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Hua-Qiao
authors: HQ
authors: Tan
authors: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Hai-Tao
authors: HT
authors: Lu
authors: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Fang
authors: F
authors: Liu
authors: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Ying-Sheng
authors: YS
authors: Cheng
authors: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Li-Ming
authors: LM
authors: Wei
authors: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Pei-Lei
authors: PL
authors: Zhang
authors: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China zhaojungongradio@hotmail.com.
authors: Jun-Gong
authors: JG
authors: Zhao
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D017130:Angioplasty / Q000009:adverse effects; D055109:Ankle Brachial Index; D001783:Blood Flow Velocity; D002908:Chronic Disease; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency
keywords: angioplasty; below-the-knee intervention; chronic total occlusion; diabetes; digital subtraction angiography; limb ischemia; limb salvage; magnetic resonance angiography; restenosis; runoff