“The renal foot”- angiographic pattern of patients with chronic limb threatening ischemia and end-stage renal disease

• Published in: Cardiovascular revascularization medicine Vol. 21; no. 1; pp. 118 - 121
• Main Authors: Baghdasaryan, Patrick A, Bae, Jun Ho, Yu, Wendy, Rowe, Vincent, Armstrong, David G, Shavelle, David M, Clavijo, Leonardo C
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020
• Subjects: Amputation; Cardiovascular; Chronic limb threatening ischemia; Critical limb ischemia; End stage renal disease; Peripheral artery disease; Peripheral artery disease; Critical limb ischemia; End stage renal disease; Chronic limb threatening ischemia; Amputation
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2019.09.001

AbstractBackgroundPatients with chronic limb threatening ischemia (CLTI) and end-stage renal disease (ESRD) have greater risk of limb loss compared to those with CLTI alone. We investigated angiographic patterns in patients with CLTI and evaluated for differences based on ESRD status. Methods. We reviewed lower extremity angiograms of 152 CLTI patients at a single academic medical center from 2011 to 2017 and analyzed them based on the Graziani and Bollinger classification systems. We used these classification systems to evauate for angiographic patterns and arterial disease severity categorized by the presence or absence of ESRD. ResultsThe analysis included 152 CLTI patients (161 angiograms). Patients' mean age was 63.4 ± 11.3 years and 20 (12.4%) patients had ESRD. In our study population, infrapopliteal arterial disease was more severe than femoropopliteal disease. Disease of the arteries providing direct flow to the plantar arch was more severe in ESRD patients compared to non-ESRD patients, evident by higher Graziani Class VII disease (20% vs. 4.9%, p = .03). ESRD patients also had higher rates of concurrent significant stenosis of the posterior tibial and lateral plantar arteries (70% vs. 23%, p < .0001). ConclusionIn people with CLTI, infrapopliteal arteries are more severely affected than proximal femoropopliteal arteries. ESRD patients exhibit a pattern of arterial disease, we termed the “renal foot,” that frequently involves arteries providing direct flow to the plantar arch.