Risk Factor
Grade
Complication
Diabetes
0
1
2
3
None
Adult onset, diet controlled
Adult onset, insulin controlled
Juvenile onset
Tobacco usea
0
1
2
3
Never or none for last 10 years
None current, but smoked in last 10 years
Less than 1 pack/dayb
Greater than 1 pack/day
Hypertension
0
1
2
3
Nonec
Easily controlled with single drug
Controlled with two drugs
Requires more than 2 drugs or uncontrolled
Hyperlipidemia
0
1
2
3
Cholesterol/triglycerides within normal limits for age
Mild elevation, controlled by diet
Types II, III, IV requiring strict diet control
Requiring diet and drug control
Cardiac Status
0
1
2
3
Asymptomatic, normal ECG
Asymptomatic, h/o MI _6 mo, or occult MI by ECG
Stable angina, controlled ectopy, or asymptomatic
arrhythmia, drug compensated CHF
Unstable angina, symptomatic or poorly controlled
ectopy/arrhythmia, poorly compensated CHF, MI
within 6 months
Carotid Disease
0
1
2
3
No symptoms, bruit, or evidence of diseased
Asymptomatic but evidence of disease
Transient or temporary stroke
Completed stroke with permanent neurologic deficit
Renal Status
0
1
2
3
No known renal disease, serum creatinine _1.5 mg/dL, creatinine clearance _50 mL/min
Serum creatinine 1.5–3.0 mg/dL, creatinine clearance 30–50 mL/min
Serum creatinine 3.0–6.0 mg/dL, creatinine clearance 15–30 mL/min
Serum creatinine _6.0 mg/dL, creatinine clearance _15 mL/min, or on dialysis or with transplant
Pulmonary Status
0
1
2
3
Asymptomatic, normal CXR, PFT 20% of predicted
Asymptomatic or mild dyspnea on exertion, mild
CXR parenchymal changes, PFT 65–80% of predicted
Between 1 and 3
PFT: VC _1.85, FEV1 _1.2 L or _35% of predicted
Max. Vol. ventilation _28 L/min or _50% of
predicted, PCO2 _45 mm Hg, supplementary
oxygen needed, pulmonary hypertension
Table 3.2
Classification of complications by outcome
|
Minor complications |
|
•No therapy, no sequela |
|
•Minor therapy or minor sequela, includes unplanned overnight hospital admission for observation only (<24 h) |
|
Major complications |
|
•Requires major therapy or unplanned hospitalization (24–48 h) |
|
•Requires major therapy, unplanned increase in the level of care, prolonged hospitalization (>48 h) |
|
•Permanent adverse sequela |
|
•Death |
Table 3.3
Clinical categories of acute limb ischemia
|
Category |
Findings |
Doppler signals | |||
|---|---|---|---|---|---|
|
Description |
Sensory loss |
Muscle weakness |
Arterial |
Venous | |
|
I. Viable |
Not immediately threatened |
None |
None |
Audible |
Audible |
|
II. Threatened | |||||
|
(a) marginal |
Salvageable if promptly treated |
Minimal (toe) or none |
None |
Often inaudible |
Audible |
|
(b) immediately |
Salvageable with immediate revascularization |
More than toes, associated with rest pain |
Mild, moderate |
Usually inaudible |
Audible |
|
III. Irreversiblea |
Major tissue loss or permanent nerve damage Inevitable |
Profound, anesthetic |
Profound, paralysis (rigor) |
Inaudible |
Inaudible |
Table 3.4
Clinical categories of chronic limb ischemia
|
Grade |
Category |
Clinical description |
Objective criteria |
|---|---|---|---|
|
0 |
0 |
Asymptomatic, no hemodynamically significant occlusive disease |
Normal results of treadmill*/stress |
|
I |
1 |
Mild claudication |
Treadmill exercise completed, postexercise AP is greater than 50 mm Hg but more than 25 mm Hg less than normal |
|
2 |
Moderate claudication |
Symptoms between those of categories 1 and 3 | |
|
3 |
Severe claudication |
Treadmill exercise cannot be completed, postexercise Ap is less than 50 mm Hg | |
|
II |
4 |
Ischemic rest pain |
Resting AP of 40 mm Hg or less, flat or barely pulsatile ankle or metatarsal plethysmographic tracing, toe pressure less than 30 mm Hg |
|
III |
5 |
Minor tissue loss, nonhealing ulcer, focal gangrene with diffuse pedal ischemia |
Resting AP of 60 mm Hg or less, ankle or metatarsal plethysmographic tracing flat or barely pulsatile, toe pressure less than 40 mm Hg |
|
6 |
Major tissue loss, extending above transmetatarsal level, functional foot no longer salvageable |
Same as for category 5 |
Table 3.5
Definitions of success for endoluminal revascularization devices
|
I.Technical: Meets the criteria for both anatomic and homodynamic success in the immediate post-procedure periods |
|
A.Anatomic: <30% final residual stenosis measured at the narrowest point of the vascular lumen
Continued anatomic: < 50% recurrent stenosis |
|
B.Hemodynamic: ABI or thigh/brachial index improved by 1.0 or greater above baseline and not deteriorated by >0.15 from the maximum early post-procedure level, or pulse volume recording distal to the reconstruction maintained at 5 mm above the preoperative tracing (only for patients with incompressible vessels) |
|
II.Clinical: Immediate improvement by at least 1 clinical category, sustained improvement by at least 1 clinical category, patients with tissue loss (categories 5 and 6) must move up at least 2 categories and reach the level of claudication to be considered improved |
Table 3.6
Definitions of improvement of lower limb arterial diseases
|
Grade |
Definition |
|---|---|
|
+3 |
Markedly improved. Symptoms are gone or markedly improved. ABI increased to >0.90 |
|
+2 |
Moderately improved. Still symptomatic but with improvement in lesion category.a ABI increased by >0.10 but not normalized |
|
+1 |
Minimally improved. Categorical improvement in symptoms without significant ABI increase (0.10 or less) or vice versa (but not both) |
|
0 |
No change. No categorical shift and less than 0.10 changes in ABI |
|
−1 |
Mildly worse. Either worsening of symptoms or decrease in ABI of >0.10 |
|
−2 |
Moderate worsening. Deterioration of the patient’s condition by one category or unexpected minor amputation |
|
−3 |
Marked worsening. Deterioration of the patient’s condition by more than one category or major amputation |
Table 3.7
Reporting requirements and recommendations for endoluminal revascularization devices
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|
Data |
Required |
Highly recommended |
Recommended |
|---|---|---|---|
|
Pretreatment evaluationa | |||
|
Risk factors/Comorbidities |
X |
||
|
Measures of disease severity | |||
|
Stenosis of treated site |
X |
||
|
Runoff grade |
X |
||
|
Eccentricity |
X | ||
|
Noninvasive indices (ABI, TBI, PVR) |
X |
||
|
Treadmill (claudicants) |
X |
||
|
graded treadmill |
X |
||
|
Functional status |
X |
||
|
Quality of life |
X |
||
|
Treatment description |
X |
||
|
Posttreatment evaluationa | |||
|
Follow-up angiogram |
X |
||
|
Technical success |
|||
|
Anatomic |
|||
|
Stenosis |
X |
||
|
Luminal gain |
X |
||
|
Hemodynamic | |||
|
Noninvasive (ABI, TBI, PVR) |
X |
||
|
intravascular pressures |
X |
||
|
Clinical success | |||
|
Improvement category |
X |
||
|
Functional status |
X |
||
|
Quality of life |
X |
||
|
Treadmill (claudicants) |
X |
||