AI Article Synopsis

  • This study focuses on chronic limb-threatening ischemia (CLTI) caused by inflammatory nonatherosclerotic diseases, highlighting how its clinical features and outcomes differ from those caused by atherosclerosis.
  • A multicenter analysis involving 414 patients showed that individuals with inflammatory nonatherosclerotic CLTI had less conventional risk factors but experienced more severe disease and complications, such as delayed wound healing and higher rates of major reintervention.
  • The findings emphasize the unique challenges in managing inflammatory nonatherosclerotic CLTI, indicating a need for tailored clinical approaches compared to those used for atherosclerotic cases.

Article Abstract

Background: The scope of clinical guidelines for the management of chronic limb-threatening ischemia (CLTI) is limited to atherosclerotic disease of the lower-extremity arteries. This study aimed to reveal the clinical features and prognoses of CLTI due to inflammatory nonatherosclerotic etiologies undergoing revascularization.

Methods: DECOPON (DatabasE of ChrOnic limb-threatening ischemia Presenting ischemic ulcer and gangrene due to nON-atherosclerotic disease) is a multicenter retrospective study that evaluated 465 limbs of 414 patients with CLTI undergoing revascularization for ischemic tissue loss with inflammatory nonatherosclerotic etiologies between 2010 and 2020. Clinical features and prognoses were compared with 930 limbs of 809 patients with atherosclerotic CLTI during the same period.

Results: The frequency of conventional atherosclerotic risk factors was significantly lower in the inflammatory nonatherosclerotic group. The inflammatory nonatherosclerotic group had more severe WIfI (wound, ischemia, and foot infection) W and fI grades, and more frequent infrapopliteal and inframalleolar artery diseases with a rarer presence of arterial calcification (all < 0.05). Adjunctive therapy was more frequently performed in the inflammatory nonatherosclerotic group ( < 0.05). The inflammatory nonatherosclerotic group had a lower incidence rate of wound healing (0.64-fold, < 0.001) and a higher incidence rate of major reintervention (2.30-fold, = 0.006), whereas the risk ratio of all-cause mortality was 0.83-fold ( = 0.067). The association of inflammatory nonatherosclerotic disease with the delayed wound healing and the susceptibility to major reintervention remained significant even after adjustment for covariates (both < 0.001).

Conclusions: Patient, limb, and lesion characteristics of inflammatory nonatherosclerotic CLTI were considerably different from those of atherosclerotic CLTI. Inflammatory nonatherosclerotic CLTI was less likely to heal than atherosclerotic CLTI.

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Source
http://dx.doi.org/10.1177/1358863X231164659DOI Listing

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