An analysis of IN.PACT DEEP randomized trial on the limitations of the societal guidelines-recommended hemodynamic parameters to diagnose critical limb.

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An analysis of IN.PACT DEEP randomized trial on the limitations of the societal guidelines-recommended hemodynamic parameters to diagnose critical limb ischemia Mehdi H. Shishehbor, DO, MPH, PhD, Tarek A. Hammad, MD, Thomas Zeller, MD, Iris Baumgartner, MD, Dierk Scheinert, MD, Krishna J. Rocha-Singh, MD Journal of Vascular Surgery Volume 63, Issue 5, Pages 1311-1317 (May 2016) DOI: 10.1016/j.jvs.2015.11.042 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Status of toe pressure parameter in patients with critical limb ischemia (CLI). Only 40 patients had an available toe pressure. The large pie shows that 24 patients (60%) met the societal guideline-recommended criteria for the toe pressure of <50 mm Hg for patients with Rutherford category 5 or 6 or <30 mm Hg in those with Rutherford category 4. The small pie shows that of those who met the criteria, 3 patients (13%) had calcified vessels, 14 (58%) had an abnormal ankle-brachial index (ABI), and 7 (29%) had a normal ABI. Journal of Vascular Surgery 2016 63, 1311-1317DOI: (10.1016/j.jvs.2015.11.042) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 Distribution of different (A) ankle-brachial index (ABI), (B) ankle pressure, and (C) toe pressure cutoffs according to the number of diseased infrapopliteal vessels. A significant proportion of our patients with critical limb ischemia (CLI), including those with two- and three-vessel infrapopliteal disease, did not meet the cutoff points for severe ischemia according to ABI and ankle pressure. Toe pressure appears to be more sensitive. Ankle pressure is considered diagnostic if <70 mm Hg for patients with Rutherford category 5 or 6, or <50 mm Hg in those with Rutherford category 4. Toe pressure is considered diagnostic if <50 mm Hg for patients with Rutherford category 5 or 6, or <30 mm Hg in those with Rutherford category 4. Journal of Vascular Surgery 2016 63, 1311-1317DOI: (10.1016/j.jvs.2015.11.042) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 Distribution of different (A) ankle-brachial index (ABI), (B) ankle pressure, and (C) toe pressure cutoffs according to the status of plantar arch. A significant proportion of our patients with critical limb ischemia (CLI) with a diseased plantar arch did not have severe ischemia according to ABI and ankle pressure measurements. Toe pressure appears to be more sensitive but not specific. Ankle pressure is considered diagnostic if <70 mm Hg for patients with Rutherford category 5 or 6, or <50 mm Hg in those with Rutherford category 4. Toe pressure is considered diagnostic if <50 mm Hg for patients with Rutherford category 5 or 6, or <30 mm Hg in those with Rutherford category 4. Journal of Vascular Surgery 2016 63, 1311-1317DOI: (10.1016/j.jvs.2015.11.042) Copyright © 2016 Society for Vascular Surgery Terms and Conditions