Purpose: To assess the correlation between inguinal lymph node characteristic and ipsilateral primary amputation rates in patients with ischemic foot ulcers who had a technically successful endovascular treatment.
Materials and Methods: A retrospective review of patients who were endovascularly treated for ischemic foot ulcers between January 2015 and May 2017 was performed. Two hundred and two limbs in 202 patients (135 male, 67 female; median age 72.8; range, 42.2-93.7 y) were technically successfully treated. Technical success was defined as occluded artery recanalization with residual stenosis < 30%, and ABI improvement by > 0.2 after 24 hours. Unilateral lymph node size, contrast enhancement, necrosis and perinodular fat infiltration were assessed on a preprocedural computer tomography angiography (CTA). Primary end points were amputation and sepsis within six months. Independent-samples t-tests and chi-square test of independence were conducted to examine relation between lymph node characteristics and amputation or septic shock.
Results: Forty-two (20.8%) patients had undergone amputation. Sepsis occurred in 6 out of 202 patients (3%). There was a significant difference in the scores of lymph node sizes between amputated and non-amputated limbs (p = 0.000). Relations between lymph node characteristics and amputation was significant (p <0.001). Patients with perinodular fat infiltration or increased node size were 5.940 and 1.109 times more likely to undergo limb amputation than those without, respectively. The relation between lymph node characteristics and septic shock was significant (p <0.05).
Conclusion: Limb amputation and ipsilateral lymph node size and characteristics are associated with in technically successful endovascular treatment of patients with ischemic foot ulcers. Moreover, increased lymph node size and perinodular fat infiltration predicted limb amputation.
