P-141 - EARLY FAILURE OF TRANSMETATARSAL AMPUTATION FOLLOWING REVASCULARIZATION IN ADVANCED CHRONIC LIMB THREATENING ISCHEMIA: RISK FACTORS ANALYSIS.

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Angherà C. (Università degli Studi di Bologna ~ Bologna ~ Italy) , Abualhina M. (Ospedale Sant'Orsola-Malpighi ~ Bologna ~ Italy) , Cappiello A. (Università degli Studi di Bologna ~ Bologna ~ Italy) , Ancetti S. (Ospedale Sant'Orsola-Malpighi ~ Bologna ~ Italy) , Pini R. (Ospedale Sant'Orsola-Malpighi ~ Bologna ~ Italy) , Gallitto E. (Ospedale Sant'Orsola-Malpighi ~ Bologna ~ Italy) , Mascoli C. (Ospedale Sant'Orsola-Malpighi ~ Bologna ~ Italy) , Faggioli G. (Università degli Studi di Bologna ~ Bologna ~ Italy) , Gargiulo M. (Università degli Studi di Bologna ~ Bologna ~ Italy)
Introduction:
Transmetatarsal amputation (TMA) after a revascularization surgery represents a limb salvage procedure for patients with advanced stages of Chronic limb threatening ischemia (CLTI). The aim of this study was toanalyze factors associated to the early failure of TMA.
Methods:
Patients treated in our center for CLTIbetween April-2012 and April-2021by revascularization and TMA were analized. All types of revascularizations were included.Patient's clinical characteristics were assessed. Extension of arterial disease was classified by the GLASS classification. Poor tibial runoff was defined as the patency of only one tibial vessel (vs two/three tibial vessels). The primary endpoint was early failure of TMA(EFTMA) defined as proximalization to major amputation within 3 months and associated risk factors.
Results:
A total of 196TMA was performed in 180 patients (mean age 74-years, male 76.9%) following lower limb endovascular and surgical revascularization. Relevant comorbidities were: diabetes mellitus 97.2%, dialysis 33.2%, coronary artery disease 36%. Treated limbs presentedRutherford stage 5 and 6 in11.2% and 88.8% respectively. Arterial lesions distribution was GLASS stage I in 9.2%, II in 59.7% and III in31.1%. In 61.4% of cases only one-tibial runoff vessel was patent. At 3-month, 38 (19.4%) TMA was transformed into major amputation regardless of the type of revascularization. Factors associated to EFTMA were: age<74-years (P=0.05), poor tibial vessels runoff (P=0.02) and primary patency loss (P<0.001). Considering TMA left open due to clinical infection, C-ReactiveProtein(CRP) reduction of >8 mg/L before closure and negative pressure therapy (NPT) use were associated with higher rates of limbsalvage(P=0.04 and P=0.03, respectively).
Conclusion:
This study results suggest thatearly failure of TMA is often associated with age <74 years-old, poor tibial vessels runoff and primary patency loss. Whenever a TMA left open during the procedure due to clinical infection, planning surgical closure is recommended after a significant CRP reduction. If surgical closure is not possible, the use of NPT is recommended.