This study states that The primary objective of the present study was to determine whether the magnitude of change in the intraoperative toe-brachial index (TBI) during endovascular procedures for atherosclerotic peripheral vascular disease (PVD) is associated with major adverse limb events (MALE) within 1 year after the procedure. We performed a prospective, operator-blinded, and blinded endpoint-adjudicated observational cohort study. The TBI was serially assessed at multiple times before, during, and after endovascular procedures for symptomatic PVD (Fig). The association between the intraoperative change in the TBI and postoperative outcomes was analyzed using Cox proportional hazards after adjustment for clustering of legs within subjects, the competing risk of mortality, and baseline clinical status of limb ischemia and vascular level of intervention. The ideal threshold of intraoperative TBI improvement to predict for freedom from MALE was calculated using Youden’s method to maximize sensitivity and specificity. Intraoperative TBI assessment during endovascular procedures for PVD was shown to be reliable and correlated strongly with postoperative clinical outcomes such as MALE. These findings suggest that intraoperative perfusion assessment could be a useful tool in guiding intraoperative decision-making, which should be evaluated with a randomized clinical trial.

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