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Current Pharmaceutical Design

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ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

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Review Article

Risk Models and Scores in Patients with Peripheral Artery Disease and Chronic Limb-threatening Ischemia: A Comprehensive Review

Author(s): Damianos G. Kokkinidis*, Adarsh Katamreddy, Stefanos Giannopoulos, Dimitrios Schizas, Sotirios Georgopoulos, Theodore Liakakos, Ehrin J. Armstrong and Christos Bakoyiannis

Volume 27, Issue 10, 2021

Published on: 30 May, 2020

Page: [1277 - 1288] Pages: 12

DOI: 10.2174/1381612826666200530214459

Price: $65

Abstract

Peripheral artery disease (PAD) affects more than 200 million patients worldwide and chronic limbthreatening ischemia (CLTI) is the most advanced stage of PAD with very high morbidity and mortality rates. Cardiovascular medicine is trending towards a more personalized approach where each individual patient will be managed according to specific risk factors, disease characteristics, expectations related to their disease and individualized assessment of potential outcomes. For this reason, a number of risk models and scores have been developed during the last few years. Our aim in this comprehensive review article is to provide an overview of selected risk models and scores for patients with PAD and CLTI. Given that some of the published scores were of low quality (minimal discriminatory ability), we included scores that were already externally validated or scores that had promising initial findings.

Available scoring systems were grouped in the five following categories according to their utility: i) scores that can detect asymptomatic patients who should be screened for PAD, ii) scores for assessment of functional status and quality of life in patients with PAD, iii) scores assessing risk for amputation and other major adverse limb events among patients with CLTI, iv) scores for the optimal revascularization strategy in each patient and scores predicting successful procedural outcomes; v) scores predicting short or long-term cardiovascular and limb related outcomes after either revascularization or at least angiographic assessment. Limitations of available scoring systems include development and validation in specific populations, lack of external validation (for some of them) and also lack of synchrony with current era endovascular technology. However, with further optimization of current scores and the development of new scores, the field of PAD and CLI can be transitioned to a personalized medicine approach.

Keywords: Peripheral artery disease, critical limb ischemia, claudication, risk models, risk scores, personalized medicine.

« Previous Next »
[1]
Fowkes FGR, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013; 382(9901): 1329-40.
[http://dx.doi.org/10.1016/S0140-6736(13)61249-0] [PMID: 23915883]
[2]
Sampson UKA, Fowkes FG, McDermott MM, et al. Global and regional burden of death and disability from peripheral artery disease: 21 world regions, 1990 to 2010. Glob Heart 2014; 9(1): 145-158.e21.
[http://dx.doi.org/10.1016/j.gheart.2013.12.008] [PMID: 25432124]
[3]
Leng GC, Fowkes FGR, Lee AJ, Dunbar J, Housley E, Ruckley CV. Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study. BMJ 1996; 313(7070): 1440-4.
[http://dx.doi.org/10.1136/bmj.313.7070.1440] [PMID: 8973232]
[4]
Pande RL, Perlstein TS, Beckman JA, Creager MA. Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to 2004. Circulation 2011; 124(1): 17-23.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.110.003954] [PMID: 21690489]
[5]
Criqui MH, Langer RD, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992; 326(6): 381-6.
[http://dx.doi.org/10.1056/NEJM199202063260605] [PMID: 1729621]
[6]
Hossain P, Kokkinidis DG, Armstrong EJ. How to assess a claudication and when to intervene. Curr Cardiol Rep 2019; 21(12): 138.
[http://dx.doi.org/10.1007/s11886-019-1227-4] [PMID: 31728766]
[7]
Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. Circulation 2017; 135(12): e686-725.
[http://dx.doi.org/10.1161/CIR.0000000000000470] [PMID: 27840332]
[8]
Elsayed S, Clavijo LC. Critical limb ischemia. Cardiol Clin 2015; 33(1): 37-47.
[http://dx.doi.org/10.1016/j.ccl.2014.09.008] [PMID: 25439329]
[9]
Varu VN, Hogg ME, Kibbe MR. Critical limb ischemia. J Vasc Surg 2010; 51(1): 230-41.
[http://dx.doi.org/10.1016/j.jvs.2009.08.073] [PMID: 20117502]
[10]
Shishehbor MH, White CJ, Gray BH, et al. Critical limb ischemia: an expert statement. J Am Coll Cardiol 2016; 68(18): 2002-15.
[http://dx.doi.org/10.1016/j.jacc.2016.04.071] [PMID: 27692726]
[11]
Kokkinidis DG, Armstrong EJ. Emerging and future therapeutic options for femoropopliteal and infrapopliteal endovascular intervention. Interv Cardiol Clin 2017; 6(2): 279-95.
[http://dx.doi.org/10.1016/j.iccl.2016.12.011] [PMID: 28257775]
[12]
Kokkinidis DG, Strobel A, Jawaid O, et al. Development and validation of a predictive score for anterograde crossing of infrapopliteal chronic total occlusions: (The Infrapop-CTO Score). Catheterization and Cardiovascular Interventions 2020; 95(3)
[13]
Bargellini I, Piaggesi A, Cicorelli A, et al. Predictive value of angiographic scores for the integrated management of the ischemic diabetic foot. J Vasc Surg 2013; 57(5): 1204-12.
[http://dx.doi.org/10.1016/j.jvs.2012.10.104] [PMID: 23332244]
[14]
Jain A, Liu K, Ferrucci L, et al. The Walking Impairment Questionnaire stair-climbing score predicts mortality in men and women with peripheral arterial disease. J Vasc Surg 2012; 55(6): 1662-73.e2.
[http://dx.doi.org/10.1016/j.jvs.2011.12.010] [PMID: 22608041]
[15]
McDermott MM, Liu K, Guralnik JM, Martin GJ, Criqui MH, Greenland P. Measurement of walking endurance and walking velocity with questionnaire: validation of the walking impairment questionnaire in men and women with peripheral arterial disease. J Vasc Surg 1998; 28(6): 1072-81.
[http://dx.doi.org/10.1016/S0741-5214(98)70034-5] [PMID: 9845659]
[16]
Ouedraogo N, Chanut M, Aubourg M, et al. Development and evaluation of the Walking Estimated-Limitation Calculated by History questionnaire in patients with claudication. J Vasc Surg 2013; 58(4): 981-8.
[http://dx.doi.org/10.1016/j.jvs.2013.03.039] [PMID: 23663870]
[17]
Jain A, Liu K, Ferrucci L, et al. Declining walking impairment questionnaire scores are associated with subsequent increased mortality in peripheral artery disease. J Am Coll Cardiol 2013; 61(17): 1820-9.
[http://dx.doi.org/10.1016/j.jacc.2013.01.060] [PMID: 23500321]
[18]
Badheka AO, Rathod AD, Bharadwaj AS, et al. Outcomes and risk prediction model for peripheral arterial disease in patients with stable coronary artery disease. Angiology 2011; 62(6): 473-9.
[http://dx.doi.org/10.1177/0003319711398650] [PMID: 21788210]
[19]
Bendermacher BLW, Teijink JAW, Willigendael EM, et al. Outcomes and risk prediction model for peripheral arterial disease in patients with stable coronary artery disease. Angiology 2007; 62: 473-9.
[20]
Duval S, Massaro JM, Jaff MR, et al. An evidence-based score to detect prevalent peripheral artery disease (PAD) Vascular medicine (London, England) 2012; 17: 342-51.
[21]
Grau M, Baena-Díez J-M, Félix-Redondo F-J, et al. Estimating the risk of peripheral artery disease using different population strategies. Prev Med 2013; 57(4): 328-33.
[http://dx.doi.org/10.1016/j.ypmed.2013.06.007] [PMID: 23769902]
[22]
López-Laguna N, Martínez-González MA, Toledo E, et al. Risk of peripheral artery disease according to a healthy lifestyle score: The PREDIMED study. Atherosclerosis 2018; 275: 133-40.
[http://dx.doi.org/10.1016/j.atherosclerosis.2018.05.049] [PMID: 29902701]
[23]
Makdisse M, Ramos LR, Moreira F, et al. A risk score for predicting peripheral arterial disease in individuals 75 years or older. Arq Bras Cardiol 2007; 88(6): 630-6.
[http://dx.doi.org/10.1590/S0066-782X2007000600002] [PMID: 17664989]
[24]
Ramos R, Baena-Díez JM, Quesada M, et al. Derivation and validation of REASON: a risk score identifying candidates to screen for peripheral arterial disease using ankle brachial index. Atherosclerosis 2011; 214(2): 474-9.
[http://dx.doi.org/10.1016/j.atherosclerosis.2010.11.015] [PMID: 21167488]
[25]
Kannel WB, Feinleib M, McNamara PM, Garrison RJ, Castelli WP. An investigation of coronary heart disease in families. The Framingham offspring study. Am J Epidemiol 1979; 110(3): 281-90.
[http://dx.doi.org/10.1093/oxfordjournals.aje.a112813] [PMID: 474565]
[26]
Sagar SP, Brown PM, Zelt DT, Pickett WL, Tranmer JE. Further clinical validation of the walking impairment questionnaire for classification of walking performance in patients with peripheral artery disease. Int J Vasc Med 2012; 2012: 190641-1.
[http://dx.doi.org/10.1155/2012/190641] [PMID: 22919494]
[27]
Abraham P, Godet R, Harbonnier M, Laneelle D, Leftheriotis G, Ouedraogo N. External validation of the “walking estimated limitation calculated by history” (WELCH) questionnaire in patients with claudication. European J Vasc Endovasc Surg 2014; 47: 319-25.
[28]
de Vries M, Ouwendijk R, Kessels AG, et al. Comparison of generic and disease-specific questionnaires for the assessment of quality of life in patients with peripheral arterial disease. J Vasc Surg 2005; 41(2): 261-8.
[http://dx.doi.org/10.1016/j.jvs.2004.11.022] [PMID: 15768008]
[29]
Kumlien C, Nordanstig J, Lundström M, Pettersson M. Validity and test retest reliability of the vascular quality of life Questionnaire-6: a short form of a disease-specific health-related quality of life instrument for patients with peripheral arterial disease. Health Qual Life Outcomes 2017; 15(1): 187-7.
[http://dx.doi.org/10.1186/s12955-017-0762-1] [PMID: 28962624]
[30]
Rutherford RB, Flanigan DP, Gupta SK, et al. Suggested standards for reports dealing with lower extremity ischemia. J Vasc Surg 1986; 4(1): 80-94.
[http://dx.doi.org/10.1016/0741-5214(86)90326-5] [PMID: 3723692]
[31]
Cull DL, Manos G, Hartley MC, et al. An early validation of the Society for Vascular Surgery lower extremity threatened limb classification system. J Vasc Surg 2014; 60(6): 1535-41.
[http://dx.doi.org/10.1016/j.jvs.2014.08.107] [PMID: 25282695]
[32]
Darling JD, McCallum JC, Soden PA, et al. Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system following infrapopliteal endovascular interventions for critical limb ischemia. J Vasc Surg 2016; 64(3): 616-22.
[http://dx.doi.org/10.1016/j.jvs.2016.03.417] [PMID: 27380993]
[33]
Beropoulis E, Stavroulakis K, Schwindt A, Stachmann A, Torsello G, Bisdas T. Validation of the Wound, Ischemia, foot Infection (WIfI) classification system in nondiabetic patients treated by endovascular means for critical limb ischemia. J Vasc Surg 2016; 64(1): 95-103.
[http://dx.doi.org/10.1016/j.jvs.2016.01.040] [PMID: 26994958]
[34]
Mayor J, Chung J, Zhang Q, et al. Using the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification to identify patients most likely to benefit from revascularization. J Vasc Surg 2019; 70(3): 776-85.e1.
[http://dx.doi.org/10.1016/j.jvs.2018.11.039] [PMID: 30922742]
[35]
Taylor SM, Kalbaugh CA, Gray BH, et al. The LEGS score: a proposed grading system to direct treatment of chronic lower extremity ischemia. Ann Surg 2003; 237(6): 812-8.
[http://dx.doi.org/10.1097/01.SLA.0000071563.19208.50] [PMID: 12796577]
[36]
Kalbaugh CA, Taylor SM, Cull DL, et al. Invasive treatment of chronic limb ischemia according to the Lower Extremity Grading System (LEGS) score: a 6-month report. J Vasc Surg 2004; 39(6): 1268-76.
[http://dx.doi.org/10.1016/j.jvs.2004.02.009] [PMID: 15192568]
[37]
Androes MP, Kalbaugh CA, Taylor SM, et al. Does a standardization tool to direct invasive therapy for symptomatic lower extremity peripheral arterial disease improve outcomes? J Vasc Surg 2004; 40(5): 907-15.
[http://dx.doi.org/10.1016/j.jvs.2004.08.046] [PMID: 15557904]
[38]
Kordzadeh A, Askari A, Panayiotopoulos YP. Validation of the Guy’s scoring system in patient selection for femoro-distal bypass grafting to a single calf or pedal artery. Vascular 2016; 24(3): 295-303.
[http://dx.doi.org/10.1177/1708538115591929] [PMID: 26088618]
[39]
Panayiotopoulos YP, Edmondson RA, Reidy JF, Taylor PR. A scoring system to predict the outcome of long femorodistal arterial bypass grafts to single calf or pedal vessels. Eur J Vasc Endovasc Surg 1998; 15(5): 380-6.
[http://dx.doi.org/10.1016/S1078-5884(98)80197-4] [PMID: 9633491]
[40]
Jalkanen JM, Wickström JE, Venermo M, Hakovirta HH. The extent of atherosclerotic lesions in crural arteries predicts survival of patients with lower limb peripheral artery disease: A new classification of crural atherosclerosis. Atherosclerosis 2016; 251: 328-33.
[http://dx.doi.org/10.1016/j.atherosclerosis.2016.04.016] [PMID: 27133479]
[41]
Wickström J-E, Jalkanen JM, Venermo M, Hakovirta HH. Crural Index and extensive atherosclerosis of crural vessels are associated with long-term cardiovascular mortality in patients with symptomatic peripheral artery disease. Atherosclerosis 2017; 264: 44-50.
[http://dx.doi.org/10.1016/j.atherosclerosis.2017.07.023] [PMID: 28763728]
[42]
Biancari F, Salenius J-P, Heikkinen M, Luther M, Ylönen K, Lepäntalo M. Risk-scoring method for prediction of 30-day postoperative outcome after infrainguinal surgical revascularization for critical lower-limb ischemia: a Finnvasc registry study. World J Surg 2007; 31(1): 217-25.
[http://dx.doi.org/10.1007/s00268-006-0242-y] [PMID: 17171494]
[43]
Kechagias A, Perälä J, Ylönen K, Mahar MAA, Biancari F. Validation of the Finnvasc score in infrainguinal percutaneous transluminal angioplasty for critical lower limb ischemia. Ann Vasc Surg 2008; 22(4): 547-51.
[http://dx.doi.org/10.1016/j.avsg.2008.01.007] [PMID: 18387781]
[44]
Schanzer A, Mega J, Meadows J, Samson RH, Bandyk DF, Conte MS. Risk stratification in critical limb ischemia: derivation and validation of a model to predict amputation-free survival using multicenter surgical outcomes data. J Vasc Surg 2008; 48(6): 1464-71.
[http://dx.doi.org/10.1016/j.jvs.2008.07.062] [PMID: 19118735]
[45]
Schanzer A, Goodney PP, Li Y, et al. Vascular Study Group of Northern New England. Validation of the PIII CLI risk score for the prediction of amputation-free survival in patients undergoing infrainguinal autogenous vein bypass for critical limb ischemia. J Vasc Surg 2009; 50(4): 769-75.
[http://dx.doi.org/10.1016/j.jvs.2009.05.055] [PMID: 19628361]
[46]
Morisaki K, Yamaoka T, Iwasa K, Ohmine T. Influence of frailty on treatment outcomes after revascularization in patients with critical limb ischemia. J Vasc Surg 2017; 66(6): 1758-64.
[http://dx.doi.org/10.1016/j.jvs.2017.04.048] [PMID: 28647199]
[47]
Morisaki K, Furuyama T, Matsubara Y, et al. External validation of CLI Frailty Index and assessment of predictive value of modified CLI Frailty Index for patients with critical limb ischemia undergoing infrainguinal revascularization. Vascular 2019; 27(4): 405-10.
[http://dx.doi.org/10.1177/1708538119836005] [PMID: 30890090]
[48]
Arvela E, Söderström M, Korhonen M, et al. Finnvasc score and modified Prevent III score predict long-term outcome after infrainguinal surgical and endovascular revascularization for critical limb ischemia. J Vasc Surg 2010; 52(5): 1218-25.
[http://dx.doi.org/10.1016/j.jvs.2010.06.101] [PMID: 20709482]
[49]
Bradbury AW, Adam DJ, Bell J, et al. BASIL Trial Participants. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: A survival prediction model to facilitate clinical decision making. J Vasc Surg 2010; 51(5)(Suppl.): 52S-68S.
[http://dx.doi.org/10.1016/j.jvs.2010.01.077] [PMID: 20435262]
[50]
Moxey PW, Brownrigg J, Kumar SS, et al. The BASIL survival prediction model in patients with peripheral arterial disease undergoing revascularization in a university hospital setting and comparison with the FINNVASC and modified PREVENT scores. J Vasc Surg 2013; 57(1): 1-7.
[http://dx.doi.org/10.1016/j.jvs.2012.04.074] [PMID: 23040797]
[51]
Cury MVM, Brochado Neto FC, Matielo MF, et al. Evaluation of the BASIL survival prediction model in patients undergoing infrapopliteal interventions for critical limb ischemia. Ann Vasc Surg 2019; 55: 85-95.
[http://dx.doi.org/10.1016/j.avsg.2018.06.007] [PMID: 30099169]
[52]
Kokkinidis DG, Arfaras-Melainis A, Giannopoulos S, et al. Statin therapy for reduction of cardiovascular and limb-related events in critical limb ischemia: A systematic review and meta-analysis. Vasc Med 2020; 25(2): 106-17.
[http://dx.doi.org/10.1177/1358863X19894055]
[53]
Kokkinidis DG, Behan S, Jawaid O, et al. Laser atherectomy and drug-coated balloons for the treatment of femoropopliteal in-stent restenosis: 2-Year outcomes. Catheter Cardiovasc Interv 2020; 95(3): 439-46.
[http://dx.doi.org/10.1002/ccd.28636] [PMID: 31816169]
[54]
Kokkinidis DG, Armstrong EJ, Giri J. Balancing weight loss and sarcopenia in elderly patients with peripheral artery disease. J Am Heart Assoc 2019; 8(13): e013200.
[http://dx.doi.org/10.1161/JAHA.119.013200] [PMID: 31257976]
[55]
Meltzer AJ, Graham A, Connolly PH, et al. The Comprehensive Risk Assessment for Bypass (CRAB) facilitates efficient perioperative risk assessment for patients with critical limb ischemia. J Vasc Surg 2013; 57(5): 1186-95.
[http://dx.doi.org/10.1016/j.jvs.2012.09.083] [PMID: 23375435]
[56]
Kobayashi N, Hirano K, Nakano M, et al. Development and validation of a new scoring system to predict wound healing after endovascular therapy in critical limb ischemia with tissue loss. J Endovasc Ther 2015; 22: 48-56.
[http://dx.doi.org/10.1177/1526602814564370]
[57]
Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005; 1(2): 219-27.
[PMID: 19758907]
[58]
Mansoor H, Elgendy IY, Williams RS, Joseph VW, Hong Y-R, Mainous AG. A risk score assessment tool for peripheral arterial disease in women: From the National Health and Nutrition Examination Survey. Clin Cardiol 2018; 41(8): 1084-90.
[http://dx.doi.org/10.1002/clc.23032] [PMID: 30039607]
[59]
Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997; 26(3): 517-38.
[http://dx.doi.org/10.1016/S0741-5214(97)70045-4] [PMID: 9308598]
[60]
Jones WS, Patel MR, Tsai TT, et al. Anatomic runoff score predicts cardiovascular outcomes in patients with lower extremity peripheral artery disease undergoing revascularization. Am Heart J 2015; 170(2): 400-8.
[http://dx.doi.org/10.1016/j.ahj.2015.04.026] [PMID: 26299239]
[61]
Conte MS, Lorenz TJ, Bandyk DF, Clowes AW, Moneta GL, Seely BL. Design and rationale of the PREVENT III clinical trial: edifoligide for the prevention of infrainguinal vein graft failure. Vasc Endovascular Surg 2005; 39(1): 15-23.
[http://dx.doi.org/10.1177/153857440503900102] [PMID: 15696244]
[62]
Gupta PK, Ramanan B, Lynch TG, et al. Development and validation of a risk calculator for prediction of mortality after infrainguinal bypass surgery. J Vasc Surg 2012; 56(2): 372-9.
[http://dx.doi.org/10.1016/j.jvs.2012.01.042] [PMID: 22632800]
[63]
Adam DJ, Beard JD, Cleveland T, et al. BASIL trial participants. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 2005; 366(9501): 1925-34.
[http://dx.doi.org/10.1016/S0140-6736(05)67704-5] [PMID: 16325694]
[64]
Shiraki T, Iida O, Takahara M, et al. Predictive scoring model of mortality after surgical or endovascular revascularization in patients with critical limb ischemia. J Vasc Surg 2014; 60(2): 383-9.
[http://dx.doi.org/10.1016/j.jvs.2014.02.059] [PMID: 24726827]

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