Correlation of cerebral small vessel disease burden with outcome after lower extremity amputation

Marcin Kolasa; Otso Arponen; Ilkka Kaartinen; Eva Saarinen; Eino Solje; Jussi Hirvonen; Miska Vuorlaakso

doi:10.1016/j.jdiacomp.2024.108829

Correlation of cerebral small vessel disease burden with outcome after lower extremity amputation

Marcin Kolasa
, Otso Arponen
, Ilkka Kaartinen
, Eva Saarinen
, Eino Solje
, Jussi Hirvonen
, Miska Vuorlaakso^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Scientific › peer-review

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Abstract

Aims: This study assessed whether changes associated with cerebral small vessel disease (CSVD) evaluated from head computed tomography (CT) images captured for non-related clinical purposes predict overall survival (OS), leg salvage (LS), and amputation-free survival (AFS) after lower extremity amputation (LEA). Methods: We retrospectively included a cohort of 240 patients who had undergone a lower extremity amputation in Tampere University Hospital between the years 2007 and 2020 and had a head CT scan (within one year before amputation). A neuroradiologist graded the white matter lesions (WMLs) and reported infarcts, and the latter's effects on OS, LS, and AFS were evaluated. Results: Altogether, 162 (67.5 %) and 91 (38.1 %) patients had WMLs and infarcts, respectively. Mild/moderate (HR 1.985, CI 95 % 1.317–2.992) and severe (HR 2.259, CI 95 % 1.501–3.399) WMLs and infarcts (HR 1.413, CI 95 % 1.029–1.940) were associated with inferior OS. After a minor amputation, mild/moderate (HR 2.012, CI 95 % 1.054–3.843) and severe (HR 3.879, CI 95 % 2.096–7.180) WMLs were similarly associated with inferior AFS. Conclusions: Overall, WML and infarcts detected on head CT scans were associated with impaired OS after LEA and AFS after minor LEA. Evaluation of CSVD could provide useful prognostic information for clinicians.

Original language	English
Article number	108829
Number of pages	8
Journal	Journal of Diabetes and its Complications
Volume	38
Issue number	9
DOIs	https://doi.org/10.1016/j.jdiacomp.2024.108829
Publication status	Published - Sept 2024
Publication type	A1 Journal article-refereed

Funding

None. Open-access funding was provided by Tampere University Hospital. The researcher O.A. received grants from the Osk. Huttunen Foundation, Sigrid Jus\u00E9lius Foundation, Relander Foundation, Finnish Medical Foundation, Cancer Foundation Finland, and Orion Research Foundation. The funders had no role in the design of this study or its execution, analyses, data interpretation, or the decision to publish the results. Open-access funding was provided by Tampere University . The researcher O.A. received grants from the Osk. Huttunen Foundation , Sigrid Jus\u00E9lius Foundation , Relander Foundation , Finnish Medical Foundation , Cancer Foundation Finland , and Orion Research Foundation . The funders had no role in the design of this study or its execution, analyses, data interpretation, or the decision to publish the results.

Funders
Relander Foundation
Cancer Foundation Finland
Tampere University Library
Orionin Tutkimussäätiö
Huttunen Foundation
Suomen Lääketieteen Säätiö
Sigrid Juséliuksen Säätiö

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Amputation
Cerebral small vessel disease
Lower limb amputation
Neuroimaging
Stroke
Survival analysis

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Endocrinology

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10.1016/j.jdiacomp.2024.108829Licence: CC BY

1-s2.0-S1056872724001557-mainFinal published version, 2.15 MBLicence: CC BY

https://urn.fi/URN:NBN:fi:tuni-202408067961Licence: CC BY

Cite this

@article{0f4b89e0ec3b449aaab414b3b70578e8,

title = "Correlation of cerebral small vessel disease burden with outcome after lower extremity amputation",

abstract = "Aims: This study assessed whether changes associated with cerebral small vessel disease (CSVD) evaluated from head computed tomography (CT) images captured for non-related clinical purposes predict overall survival (OS), leg salvage (LS), and amputation-free survival (AFS) after lower extremity amputation (LEA). Methods: We retrospectively included a cohort of 240 patients who had undergone a lower extremity amputation in Tampere University Hospital between the years 2007 and 2020 and had a head CT scan (within one year before amputation). A neuroradiologist graded the white matter lesions (WMLs) and reported infarcts, and the latter's effects on OS, LS, and AFS were evaluated. Results: Altogether, 162 (67.5 \%) and 91 (38.1 \%) patients had WMLs and infarcts, respectively. Mild/moderate (HR 1.985, CI 95 \% 1.317–2.992) and severe (HR 2.259, CI 95 \% 1.501–3.399) WMLs and infarcts (HR 1.413, CI 95 \% 1.029–1.940) were associated with inferior OS. After a minor amputation, mild/moderate (HR 2.012, CI 95 \% 1.054–3.843) and severe (HR 3.879, CI 95 \% 2.096–7.180) WMLs were similarly associated with inferior AFS. Conclusions: Overall, WML and infarcts detected on head CT scans were associated with impaired OS after LEA and AFS after minor LEA. Evaluation of CSVD could provide useful prognostic information for clinicians.",

keywords = "Amputation, Cerebral small vessel disease, Lower limb amputation, Neuroimaging, Stroke, Survival analysis",

author = "Marcin Kolasa and Otso Arponen and Ilkka Kaartinen and Eva Saarinen and Eino Solje and Jussi Hirvonen and Miska Vuorlaakso",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = sep,

doi = "10.1016/j.jdiacomp.2024.108829",

language = "English",

volume = "38",

journal = "Journal of Diabetes and its Complications",

issn = "1056-8727",

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TY - JOUR

T1 - Correlation of cerebral small vessel disease burden with outcome after lower extremity amputation

AU - Kolasa, Marcin

AU - Arponen, Otso

AU - Kaartinen, Ilkka

AU - Saarinen, Eva

AU - Solje, Eino

AU - Hirvonen, Jussi

AU - Vuorlaakso, Miska

PY - 2024/9

Y1 - 2024/9

N2 - Aims: This study assessed whether changes associated with cerebral small vessel disease (CSVD) evaluated from head computed tomography (CT) images captured for non-related clinical purposes predict overall survival (OS), leg salvage (LS), and amputation-free survival (AFS) after lower extremity amputation (LEA). Methods: We retrospectively included a cohort of 240 patients who had undergone a lower extremity amputation in Tampere University Hospital between the years 2007 and 2020 and had a head CT scan (within one year before amputation). A neuroradiologist graded the white matter lesions (WMLs) and reported infarcts, and the latter's effects on OS, LS, and AFS were evaluated. Results: Altogether, 162 (67.5 %) and 91 (38.1 %) patients had WMLs and infarcts, respectively. Mild/moderate (HR 1.985, CI 95 % 1.317–2.992) and severe (HR 2.259, CI 95 % 1.501–3.399) WMLs and infarcts (HR 1.413, CI 95 % 1.029–1.940) were associated with inferior OS. After a minor amputation, mild/moderate (HR 2.012, CI 95 % 1.054–3.843) and severe (HR 3.879, CI 95 % 2.096–7.180) WMLs were similarly associated with inferior AFS. Conclusions: Overall, WML and infarcts detected on head CT scans were associated with impaired OS after LEA and AFS after minor LEA. Evaluation of CSVD could provide useful prognostic information for clinicians.

AB - Aims: This study assessed whether changes associated with cerebral small vessel disease (CSVD) evaluated from head computed tomography (CT) images captured for non-related clinical purposes predict overall survival (OS), leg salvage (LS), and amputation-free survival (AFS) after lower extremity amputation (LEA). Methods: We retrospectively included a cohort of 240 patients who had undergone a lower extremity amputation in Tampere University Hospital between the years 2007 and 2020 and had a head CT scan (within one year before amputation). A neuroradiologist graded the white matter lesions (WMLs) and reported infarcts, and the latter's effects on OS, LS, and AFS were evaluated. Results: Altogether, 162 (67.5 %) and 91 (38.1 %) patients had WMLs and infarcts, respectively. Mild/moderate (HR 1.985, CI 95 % 1.317–2.992) and severe (HR 2.259, CI 95 % 1.501–3.399) WMLs and infarcts (HR 1.413, CI 95 % 1.029–1.940) were associated with inferior OS. After a minor amputation, mild/moderate (HR 2.012, CI 95 % 1.054–3.843) and severe (HR 3.879, CI 95 % 2.096–7.180) WMLs were similarly associated with inferior AFS. Conclusions: Overall, WML and infarcts detected on head CT scans were associated with impaired OS after LEA and AFS after minor LEA. Evaluation of CSVD could provide useful prognostic information for clinicians.

KW - Amputation

KW - Cerebral small vessel disease

KW - Lower limb amputation

KW - Neuroimaging

KW - Stroke

KW - Survival analysis

U2 - 10.1016/j.jdiacomp.2024.108829

DO - 10.1016/j.jdiacomp.2024.108829

M3 - Article

AN - SCOPUS:85199430894

SN - 1056-8727

VL - 38

JO - Journal of Diabetes and its Complications

JF - Journal of Diabetes and its Complications

IS - 9

M1 - 108829

ER -

Correlation of cerebral small vessel disease burden with outcome after lower extremity amputation

Abstract

Funding

UN SDGs

Keywords

Publication forum classification

ASJC Scopus subject areas

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