P-102 - EXTRAVASCULAR INCIDENTAL FINDINGS IN CT ANGIOGRAPHY ARE ASSOCIATED WITH LOWER AMPUTATION-FREE SURVIVAL IN PATIENTS WITH ACUTE LOWER LIMB ISCHAEMIA

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Kulezic A. (Lund University ~ Lund ~ Sweden) , Acosta S. (Lund University ~ Lund ~ Sweden) , Olle E. (Lund University ~ Lund ~ Sweden) , Lehti L. (Lund University ~ Lund ~ Sweden)
Introduction:
Emergency computed tomography angiography (CTA) is the most important imaging modality to visualize arterial occlusions in patients with acute lower limb ischaemia (ALI). Extra-vascular incidental findings (EVIFs) have received less attention. The aims of this study were to evaluate the incidence of EVIFs of immediate clinical relevance in patients with ALI undergoing CTA and evaluate the association between EVIFs and emergency revascularization and amputation-free survival at 1 year.
Methods:
Retrospective study. ALI is defined as a symptom duration of less than two weeks. Emergency CTA in patients with ALI between 2015 and 2018 were independently re-evaluated by two radiologists (one interventional radiologist and one general radiologists with 14 years respectively 20 years clinical experience). EVIFs were classified into immediate (category 1), potential (category 2) or no clinical relevance (category 3). The inter-rater reliability between the first and second rater of EVIF category I was evaluated with intra-class correlation (ICC) with 95% CI and a value > 0.7 was regarded as satisfactory Multivariable binary logistic regression analysis was expressed in Odds ratios (OR) with 95% confidence intervals (CI).
Results:
The ICC coefficient for EVIF category I between the raters was 0.94 (95% CI 0.92-0.96). Among 118 patients with ALI, 78 patients underwent emergency revascularization. Forty-six EVIFs (34 patients) were category 1, of which 63% were found in the chest, including pleural effusion (n=12), pneumonia (n=8) and cardiac thrombus (n=4). Ascites (n=4) and cancer disease (n=4) were other category 1 findings. Category 1 EVIFs were associated with reduced rate of emergency revascularization (OR 0.26, 95% CI 0.10-0.66) and increased rate of combined major amputation/mortality at 1 year (OR 2.9, 95% CI 1.1-8.2).
Conclusion:
EVIFs of immediate clinical relevance are very common in emergency CTA in patients with ALI, and these EVIFs were associated with both reduced emergency revascularization and amputation free survival at one year. Therefore, it is important to evaluate EVIFs in CTA carefully even if clinical focus is on vascular evaluation.