title: Useful predictors for critical limb ischemia in severely ischemic limbs.
abstract: BACKGROUND
  The aim of this paper was to determine useful predictors for critical limb ischemia (CLI) occurrence in severely ischemic limbs. The contralateral limbs of patients with unilateral CLI were evaluated, with special respect to pulse volume recording (PVR).
  
  
  METHODS
  Retrospective analysis of 102 consecutive patients (110 limbs) with unilateral CLI. We excluded patients with bilateral CLI, or without PVR data. PVR data were automatically quantitatively expressed as upstroke time (UT) and percentage mean artery pressure (%MAP). The role of PVR parameters was examined in relation to arterial occlusive disease in the lower limbs. Baseline characteristics and non-invasive laboratory data (including Ankle Brachial Index [ABI] and PVR data) were analyzed as predictors for CLI.
  
  
  RESULTS
  After exclusion, 73 contralateral limbs of unilateral CLI patients (mean age, 70±12 years; 51 male, 70%) were investigated. Fifty patients (68%) had diabetes, and 41 patients (56%) were receiving hemodialysis. UT was longer in patients with crural arterial occlusive disease (214±55 versus 183±57 ms, P=0.02), although ABI was not different (P=0.31). In the follow-up of 19±12 months, 25 limbs progressed to CLI, and the cumulative incidence was 28% and 51% at 1 and 3 years, respectively. Multivariate analysis confirmed that abnormal %MAP (hazard ratio 5.9; 95% confidence interval, 1.8-27.0; P<0.01), coronary artery disease (CAD), and hypoalbuminemia were significant risk factors.
  
  
  CONCLUSIONS
  %MAP, CAD, and hypoalbuminemia predicted CLI occurrence in the contralateral limbs of unilateral CLI patients.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan - tmiyata-tky@umin.ac.jp.
authors.forename: Takuro
authors.initials: T
authors.lastname: Shirasu
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Miyata
authors.forename: Ayako
authors.initials: A
authors.lastname: Nishiyama
authors.forename: Takuya
authors.initials: T
authors.lastname: Miyahara
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Hoshina
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shigematsu
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D062186:Arterial Pressure; D016009:Chi-Square Distribution; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology; D015994:Incidence; D007511:Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D016016:Proportional Hazards Models; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014041:Tokyo / Q000453:epidemiology