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Utility of a Simplified Iliac Artery Calcium Scoring System to Guide Perioperative Management for Renal Transplantation

Non-contrast computed tomography scans of the abdomen and pelvis (CTAP) are often obtained prior to renal transplant to evaluate the iliac arteries and help guide surgical implantation. The purpose of this study was to describe the association of iliac calcification scores with operative and clinica...

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Autores principales: Werlin, Evan C., Braun, Hillary J., Walker, Joy P., Freise, Jonathan E., Amara, Dominic, Liu, Iris H., Mello, Anna, Tavakol, Mehdi, Stock, Peter G., Hiramoto, Jade S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007790/
https://www.ncbi.nlm.nih.gov/pubmed/33796543
http://dx.doi.org/10.3389/fmed.2021.606835
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author Werlin, Evan C.
Braun, Hillary J.
Walker, Joy P.
Freise, Jonathan E.
Amara, Dominic
Liu, Iris H.
Mello, Anna
Tavakol, Mehdi
Stock, Peter G.
Hiramoto, Jade S.
author_facet Werlin, Evan C.
Braun, Hillary J.
Walker, Joy P.
Freise, Jonathan E.
Amara, Dominic
Liu, Iris H.
Mello, Anna
Tavakol, Mehdi
Stock, Peter G.
Hiramoto, Jade S.
author_sort Werlin, Evan C.
collection PubMed
description Non-contrast computed tomography scans of the abdomen and pelvis (CTAP) are often obtained prior to renal transplant to evaluate the iliac arteries and help guide surgical implantation. The purpose of this study was to describe the association of iliac calcification scores with operative and clinical outcomes using a simplified scoring system. A retrospective review of 204 patients who underwent renal transplant from 1/2013 to 11/2014 and who had a CTAP within 3 years prior to transplant was performed. Data were collected from the electronic medical record. Common iliac artery (CIA) and external iliac artery (EIA) calcification on CTAP were assessed using a simple scoring system. Descriptive statistics, logistic regression, and survival analyses were performed. A total of 204 patients were included in the analysis. The mean age was 57.4 ± 11.2 years and 134/204 (66%) were men. Nineteen patients (9%) had a history of peripheral artery disease (PAD), 78 (38%) had coronary artery disease, and 22 (11%) had a previous cerebrovascular accident (CVA). Patients with severe right EIA plaque morphology were significantly more likely to require arterial reconstruction compared to those without severe plaque (3/14[21%] 4/153 [3%], p = 0.03). Eleven patients (5%) had one or more amputations (toe, foot, or transtibial) following transplant. In UV logistic regression, severe EIA plaque morphology (OR 8.1, CI 2.2–29.6, p = 0.002) and PAD (OR 10.7, CI 2.8–39.9, p = 0.0004) were associated with increased odds of amputation. In the MV model containing both variables, EIA plaque morphology (OR 4.4, CI 0.99–18.3, p = 0.04) and PAD (OR 6.3, CI 1.4–26.4, p = 0.01) remained independently associated with increased odds of amputation. Over a median follow up of 3.3 years (IQR 2.9–3.6), 21 patients (10%) had post-operative major adverse cardiac events (MACE, defined as myocardial infarction, coronary intervention, or CVA), and 23 patients died (11%). In unadjusted Kaplan Meier analysis, CIA plaque (p = 0.00081) and >75% CIA length calcification (p = 0.0015) were significantly associated with MACE. Plaque burden in the EIA is associated with increased need for intra-operative arterial reconstruction and post-operative lower extremity amputations, while CIA plaque is associated with post-operative MACE. Assessment of CIA and EIA calcification scores on pre-transplant CT scans in high risk patients may guide operative strategy and perioperative management to improve clinical outcomes.
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spelling pubmed-80077902021-03-31 Utility of a Simplified Iliac Artery Calcium Scoring System to Guide Perioperative Management for Renal Transplantation Werlin, Evan C. Braun, Hillary J. Walker, Joy P. Freise, Jonathan E. Amara, Dominic Liu, Iris H. Mello, Anna Tavakol, Mehdi Stock, Peter G. Hiramoto, Jade S. Front Med (Lausanne) Medicine Non-contrast computed tomography scans of the abdomen and pelvis (CTAP) are often obtained prior to renal transplant to evaluate the iliac arteries and help guide surgical implantation. The purpose of this study was to describe the association of iliac calcification scores with operative and clinical outcomes using a simplified scoring system. A retrospective review of 204 patients who underwent renal transplant from 1/2013 to 11/2014 and who had a CTAP within 3 years prior to transplant was performed. Data were collected from the electronic medical record. Common iliac artery (CIA) and external iliac artery (EIA) calcification on CTAP were assessed using a simple scoring system. Descriptive statistics, logistic regression, and survival analyses were performed. A total of 204 patients were included in the analysis. The mean age was 57.4 ± 11.2 years and 134/204 (66%) were men. Nineteen patients (9%) had a history of peripheral artery disease (PAD), 78 (38%) had coronary artery disease, and 22 (11%) had a previous cerebrovascular accident (CVA). Patients with severe right EIA plaque morphology were significantly more likely to require arterial reconstruction compared to those without severe plaque (3/14[21%] 4/153 [3%], p = 0.03). Eleven patients (5%) had one or more amputations (toe, foot, or transtibial) following transplant. In UV logistic regression, severe EIA plaque morphology (OR 8.1, CI 2.2–29.6, p = 0.002) and PAD (OR 10.7, CI 2.8–39.9, p = 0.0004) were associated with increased odds of amputation. In the MV model containing both variables, EIA plaque morphology (OR 4.4, CI 0.99–18.3, p = 0.04) and PAD (OR 6.3, CI 1.4–26.4, p = 0.01) remained independently associated with increased odds of amputation. Over a median follow up of 3.3 years (IQR 2.9–3.6), 21 patients (10%) had post-operative major adverse cardiac events (MACE, defined as myocardial infarction, coronary intervention, or CVA), and 23 patients died (11%). In unadjusted Kaplan Meier analysis, CIA plaque (p = 0.00081) and >75% CIA length calcification (p = 0.0015) were significantly associated with MACE. Plaque burden in the EIA is associated with increased need for intra-operative arterial reconstruction and post-operative lower extremity amputations, while CIA plaque is associated with post-operative MACE. Assessment of CIA and EIA calcification scores on pre-transplant CT scans in high risk patients may guide operative strategy and perioperative management to improve clinical outcomes. Frontiers Media S.A. 2021-03-16 /pmc/articles/PMC8007790/ /pubmed/33796543 http://dx.doi.org/10.3389/fmed.2021.606835 Text en Copyright © 2021 Werlin, Braun, Walker, Freise, Amara, Liu, Mello, Tavakol, Stock and Hiramoto. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Werlin, Evan C.
Braun, Hillary J.
Walker, Joy P.
Freise, Jonathan E.
Amara, Dominic
Liu, Iris H.
Mello, Anna
Tavakol, Mehdi
Stock, Peter G.
Hiramoto, Jade S.
Utility of a Simplified Iliac Artery Calcium Scoring System to Guide Perioperative Management for Renal Transplantation
title Utility of a Simplified Iliac Artery Calcium Scoring System to Guide Perioperative Management for Renal Transplantation
title_full Utility of a Simplified Iliac Artery Calcium Scoring System to Guide Perioperative Management for Renal Transplantation
title_fullStr Utility of a Simplified Iliac Artery Calcium Scoring System to Guide Perioperative Management for Renal Transplantation
title_full_unstemmed Utility of a Simplified Iliac Artery Calcium Scoring System to Guide Perioperative Management for Renal Transplantation
title_short Utility of a Simplified Iliac Artery Calcium Scoring System to Guide Perioperative Management for Renal Transplantation
title_sort utility of a simplified iliac artery calcium scoring system to guide perioperative management for renal transplantation
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007790/
https://www.ncbi.nlm.nih.gov/pubmed/33796543
http://dx.doi.org/10.3389/fmed.2021.606835
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