Predictors for Better Blood-Flow Restoration of Long-Segmental Below-the-Knee Chronic Total Occlusions after Endovascular Therapy in Diabetic Patients.
To prospectively investigate predictors for good restoration of blood flow of below-the-knee (BTK) chronic total occlusions (CTOs) after endovascular therapy in diabetes mellitus (DM) patients.



A total of 120 long-segmental (≥ 5 cm) BTK, CTOs in 81 patients who underwent recanalization were included in this study. After angioplasty, blood-flow restoration was assessed using modified thrombolysis in myocardial ischemia grades and classified as good flow (grade 3) and poor flow (grade 1/2). One hundred and six CTOs with successful recanalization were divided into a good flow group (GFG; n = 68) and poor flow group (PFG; n = 38). Multivariate logistic regression analyses were undertaken to determine independent predictors of blood-flow restoration. Receiver operating characteristic curves were constructed to determine the best cutoff value. The prevalence of target-lesion restenosis during follow-up was compared between two groups.



Univariate analyses suggested that CTOs in GFG were characterized by lighter limb ischemia (p= 0.03), shorter course of ischemic symptoms (p< 0.01) and lesion length (p= 0.04), more frequent use of intraluminal angioplasty (p= 0.03), and higher runoff score (p< 0.01) than those in PFG. Multivariate regression analyses suggested that distal runoffs (p= 0.001; odds ratio [OR], 10.32; 95% confidence interval [CI]: 4.082-26.071) and lesion length (p< 0.001; OR, 1.26; 95% CI: 1.091-1.449) were independent predictors for good flow restoration. Kaplan-Meier analyses at 12 months showed a higher prevalence of non-restenosis in GFG (p< 0.01).



Distal runoffs and lesion length are independent predictors for good flow restoration for long-segmental BTK, CTOs in DM patients who receive endovascular therapy.
Department of Radiology, Chonnam National University Medical School, Gwangju 501757, Korea.
Xiao-Li
XL
Song
Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Yue-Qi
YQ
Zhu
Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Hai-Tao
HT
Lu
Department of Endocrinology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Fang
F
Liu
Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Li-Ming
LM
Wei
Department of Radiology, Chonnam National University Medical School, Gwangju 501757, Korea.
Heoung Keun
HK
Kang
Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Jun-Gong
JG
Zhao
D000368:Aged; D019540:Area Under Curve; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001783:Blood Flow Velocity / Q000502:physiology*; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D053208:Kaplan-Meier Estimate; D007719:Knee Joint / Q000098:blood supply*; D023821:Limb Salvage; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome
Below the knee; Blood flow restoration; Chronic total occlusion; DM; Diabetes mellitus; Endovascular treatment; Extremity