PURPOSE To assess a novel tibial artery perfusion score (TPS) for predicting limb salvage in critical limb ischemia (CLI) patients undergoing percutaneous vascular intervention (PVI). PATIENTS AND METHODS A consecutive cohort of 115 CLI patients undergoing PVI in 144 limbs from 2011 to 2016 was analyzed. TPS comprised a 27-point scale based on: (1) patent tibial vessels following PVI, (2) severity of calcification of the tibial arteries, (3) presence of an intact pedal arch following intervention, (4) whether or not revascularization was direct or indirect based on the target angiosome, (5) presence of angiosome blush at the completion of index intervention. Limbs were stratified into (1) High [21-27 points], (2) Medium [13-20 points], and (3) Low [0-12 points] TPS. Predictive value of TPS was evaluated using logistic regression and Cox proportional hazards models. RESULTS The median follow-up was 15.7 months (range 0.4-69.9 months). Limb salvage in High, Medium, and Low TPS groups was 90.6%, 85.9%, and 55.6%, respectively, as freedom from the composite outcome: (1) limb complication resulting in death, (2) tibial bypass surgery, (3) above-the-knee amputation, or (4) below-the-knee amputation in patients without supratibial disease at the time of PVI. TPS was significantly associated with limb salvage defined as freedom from both the composite outcome and major amputation. CONCLUSIONS Based on this preliminary investigation, TPS was associated with limb salvage in CLI limbs, particularly in high-risk limbs. Further validation in a prospective cohort may identify patients with high-risk limbs in need of closer surveillance and earlier reintervention. LEVEL OF EVIDENCE Level IV, case series.

中文翻译：

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使用复合胫骨动脉灌注评分对经皮血管介入治疗后的肢体抢救进行预测。

目的评估新的胫骨动脉灌注评分（TPS），以预测在进行经皮血管介入治疗（PVI）的严重肢体缺血（CLI）患者中的肢体抢救。患者与方法分析了2011年至2016年间144肢中115例行PVI的CLI患者。TPS包括27分制，基于：（1）PVI后的胫骨上血管新生，（2）胫骨钙化的严重程度，（3）介入后是否存在完整的足弓弓形，（4）是否进行血运重建直接或间接基于目标血管小体，（5）在指标干预完成时出现血管小体脸红。肢体分为（1）TPS高（21-27分），（2）中[13-20分]和（3）低[0-12分]。使用Logistic回归和Cox比例风险模型评估TPS的预测价值。结果中位随访时间为15.7个月（范围为0.4-69.9个月）。高，中，低TPS组的肢体抢救率分别为90.6％，85.9％和55.6％，因为他们没有复合结果：（1）肢体并发症导致死亡；（2）胫骨搭桥手术；（3）上肢截肢，或（4）在进行PVI时无上睑上皮疾病的患者进行膝下截肢。TPS与肢体抢救显着相关，该肢抢救被定义为无综合结局和主要截肢者。结论基于此初步研究，TPS与CLI肢体，特别是高危肢体的肢体抢救相关。在前瞻性队列中的进一步验证可能会确定需要密切监视和早期再次干预的高危肢体患者。证据级别第四级，案例系列。