Vascular medicine (London, England) · 2026
Sciatic nerve atrophy as a predictor of impaired wound healing in patients with chronic limb-threatening ischemia following endovascular therapy: A prospective pilot study.
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Yang Xinzhi, Cheng Gong, Li Pengyu, Yan Ziguang, Zhang Bihui, She Kang, Zhang Jue, Niu Guochen, Yang Min
Аннотация
BACKGROUND: A prior retrospective single-center study involving patients with chronic limb-threatening ischemia (CLTI) demonstrated that sciatic nerve atrophy (SNA) is associated with impaired wound healing (IWH) and reduced amputation-free survival (AFS). We conducted a prospective single-center pilot study to validate the prognostic implications of SNA in predicting wound healing and AFS.
METHODS: Patients diagnosed with CLTI and associated tissue loss were recruited for participation in this prospective, noninterventional study. The cross-sectional area (CSA) of the sciatic nerve at the mid-to-lower femoral quarter was quantified utilizing computed tomography imaging. SNA was identified based on the predefined CSA threshold. Patient outcomes were evaluated through outpatient clinic visits and telephone follow-ups. Outcomes assessed included wound healing rate, adverse wound outcomes (AWO), and AFS.
RESULTS: In the cohort of 52 limbs with CLTI from 52 patients, 19 individuals were categorized into the SNA group. The 6-month wound healing rate was significantly lower in the SNA group (15.8%) compared to the normal group (87.9%) (p < 0.001). The sensitivity and specificity of SNA for predicting AWO at 6 months were 80.0% and 90.6%, respectively. Patients in the SNA group had significantly lower AFS at 1 year (68.4% vs 93.9%, p = 0.011). Multivariable analysis further established that SNA was an independent prognostic factor for both AWO (hazard ratio [HR]: 0.113; 95% CI: 0.034-0.381; p < 0.001) and AFS (HR: 6.135; 95% CI: 1.236-30.303; p = 0.026) following endovascular therapy (EVT).
CONCLUSIONS: SNA was identified as a predictor for AWO and AFS in patients with CLTI after EVT. Future research should involve rigorous basic and large-scale clinical studies to elucidate the association between SNA and prognosis in patients with peripheral artery disease (PAD)/CLTI and explore the underlying pathophysiological mechanisms.
METHODS: Patients diagnosed with CLTI and associated tissue loss were recruited for participation in this prospective, noninterventional study. The cross-sectional area (CSA) of the sciatic nerve at the mid-to-lower femoral quarter was quantified utilizing computed tomography imaging. SNA was identified based on the predefined CSA threshold. Patient outcomes were evaluated through outpatient clinic visits and telephone follow-ups. Outcomes assessed included wound healing rate, adverse wound outcomes (AWO), and AFS.
RESULTS: In the cohort of 52 limbs with CLTI from 52 patients, 19 individuals were categorized into the SNA group. The 6-month wound healing rate was significantly lower in the SNA group (15.8%) compared to the normal group (87.9%) (p < 0.001). The sensitivity and specificity of SNA for predicting AWO at 6 months were 80.0% and 90.6%, respectively. Patients in the SNA group had significantly lower AFS at 1 year (68.4% vs 93.9%, p = 0.011). Multivariable analysis further established that SNA was an independent prognostic factor for both AWO (hazard ratio [HR]: 0.113; 95% CI: 0.034-0.381; p < 0.001) and AFS (HR: 6.135; 95% CI: 1.236-30.303; p = 0.026) following endovascular therapy (EVT).
CONCLUSIONS: SNA was identified as a predictor for AWO and AFS in patients with CLTI after EVT. Future research should involve rigorous basic and large-scale clinical studies to elucidate the association between SNA and prognosis in patients with peripheral artery disease (PAD)/CLTI and explore the underlying pathophysiological mechanisms.
Предметные рубрики MeSH
HumansPilot ProjectsWound HealingMaleFemaleProspective StudiesAgedIschemiaRisk FactorsMiddle AgedEndovascular ProceduresTreatment OutcomeTime FactorsSciatic NervePredictive Value of TestsAtrophyAmputation, SurgicalChronic DiseaseLimb SalvageProgression-Free SurvivalAged, 80 and overPeripheral Arterial DiseaseChronic Limb-Threatening Ischemia