Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Predictors for Better Blood-Flow Restoration of Long-Segmental Below-the-Knee Chronic Total Occlusions after Endovascular Therapy in Diabetic Patients

  • Song, Xiao-Li (Department of Radiology, Chonnam National University Medical School) ;
  • Zhu, Yue-Qi (Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Lu, Hai-Tao (Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Liu, Fang (Department of Endocrinology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Wei, Li-Ming (Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Kang, Heoung Keun (Department of Radiology, Chonnam National University Medical School) ;
  • Zhao, Jun-Gong (Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital)
  • Received : 2016.03.07
  • Accepted : 2016.06.26
  • Published : 2016.11.01
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Abstract

Objective: 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. Materials and Methods: A total of 120 long-segmental (${\geq}5cm$) 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. Results: 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 nonrestenosis in GFG (p < 0.01). Conclusion: Distal runoffs and lesion length are independent predictors for good flow restoration for long-segmental BTK, CTOs in DM patients who receive endovascular therapy.

Keywords

Acknowledgement

Supported by : National Natural Science Foundation of China

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