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Published online before print March 20, 2003, 10.1148/radiol.2272020137
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(Radiology 2003;227:419-425.)
© RSNA, 2003

Vascular and Interventional Radiology

Endovascular Revascularization Below the Knee: 6-month Results and Predictive Value of C-reactive Protein Level1

Martin Schillinger, MD, Markus Exner, MD, Wolfgang Mlekusch, MD, Markus Haumer, MD, Helmut Rumpold, MD, Ramazanali Ahmadi, MD, Schila Sabeti, MD, Oswald Wagner, MD and Erich Minar, MD

1 From the Departments of Angiology (M.S., R.A., S.S., E.M.) and Laboratory Medicine (M.E., W.M., M.H., H.R., O.W.), University of Vienna Medical School, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Received February 21, 2002; revision requested April 22; final revision received August 29; accepted September 23. Address correspondence to M.S. (e-mail: martin.schillinger@akh-wien.ac.at).

PURPOSE: To determine the association between pre- and postintervention serum C-reactive protein (CRP) levels and 6-month restenosis after endovascular treatment of atherosclerotic lesions in arteries below the knee.

MATERIALS AND METHODS: Eighty-nine patients with peripheral arterial disease underwent primary successful percutaneous transluminal angioplasty (PTA) of the distal popliteal, anterior tibial, posterior tibial, and fibular arteries. Six-month patency was evaluated with the ankle brachial index (ABI) and color-coded duplex ultrasonography (US). The association between restenosis and preintervention and 48-hour postintervention CRP levels was assessed with multiple logistic regression analysis.

RESULTS: ABI improved from a preintervention median of 0.54 to a postintervention median of 0.75 (P < .001). The primary technical success rate was 94% (100 of 106). In 50 patients, a suboptimal technical result was achieved with 30%–40% residual stenosis at the dilated segment. The median ABI at 6 months was 0.65, and it was inversely correlated with preintervention (r = -0.27, P = .009) and 48-hour postintervention (r = -0.40, P < .001) CRP levels. With duplex US at 6 months, restenosis (>=50%) occurred in 36 patients. Patients with a preintervention CRP level of 0.23–0.92 mg/dL (2.3–9.2 mg/L) had a 3.7-fold increased adjusted risk for restenosis (P = .05); patients with a preintervention CRP level greater than 0.92 mg/dL (9.2 mg/L) had a 4.7-fold increased adjusted risk (P = .03). Postintervention CRP values greater than 2.42 mg/dL (24.2 mg/L) were associated with a 10.7-fold adjusted risk for restenosis (P = .002). Suboptimal PTA result was the only other parameter associated with an increased risk for restenosis (odds ratio, 3.7; P = .03).

CONCLUSION: Pre- and postintervention CRP levels were associated with restenosis after PTA of the distal popliteal and tibioperoneal arteries, which indicates that inflammation plays a crucial role in the pathophysiology of this process.

© RSNA, 2003

Index terms: Arteries, restenosis, 92.454, 92.458, 92.721 • Arteries, transluminal angioplasty, 92.1282, 92.454, 92.721 • Arteritis, 92.29, 92.454, 92.458




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