Authors
Belov Yu.V.1, 2, Chernyavin M.P.3, Davtyan A.G.4, Molokhoev E.B.4, Pankov A.S.4, Kirakosyan V.R.4, Kemov S.Sh.5, Myasoedova E.I.6
1 Petrovsky National Research Centre of Surgery, Moscow
2 I.M. Sechenov First Moscow State Medical University, Moscow
3 Burdenko Main Military Clinical Hospital, Moscow
4 Clinical Hospital №1 (Volynskaya), Moscow
5 North Caucasian State Academy, Cherkessk
6 Central State Medical Academy of the Administration of the President of the Russian Federation, Moscow
Abstract
Acute lower limb ischemia (ALLI) is a critical vascular condition associated with a high risk of amputation and mortality. The main etiological factors of ALLI include thrombosis and embolism, and the choice of optimal revascularization strategy plays a key role in clinical outcomes. Modern endovascular approaches, including catheter-directed thrombolysis, demonstrate effectiveness comparable to open surgery while being less invasive.
An important aspect of treatment optimization is the objective assessment of revascularization outcomes and prediction of clinical results. For this purpose, the TOPI (Treatment Of Peripheral Ischemia) scale was developed for angiographic evaluation of blood flow restoration. The aim of this study was to validate the TOPI scale for assessing the effectiveness of arterial revascularization and predicting outcomes in patients with acute lower limb ischemia following catheter-directed thrombolysis.
Materials and Methods: This prospective study included 69 patients with ALLI stages IIA–IIIA (according to the Saveliev–Zatevakhin classification) treated between 2016 and 2025. All patients underwent catheter-directed thrombolysis. Revascularization effectiveness was assessed using the TOPI scale (1–5 points) immediately after the procedure. Technical success, clinical outcomes, amputation rates, and perioperative complications were analyzed.
Results: Technical success of catheter-directed thrombolysis was achieved in 86.4% of patients. TOPI scores were distributed as follows: 5 points in 60.9% of cases, 4 points in 17.4%, 3 points in 11.6%, 2 points in 7.2%, and 1 point in 2.9%. The amputation rate was 7.2%, consistent with published data. Early postoperative mortality was 1.4%, associated with hemorrhagic stroke. Perioperative complications occurred in 5.8% of patients, mainly represented by access-site bleeding and pseudoaneurysm formation. A statistically significant association was observed between TOPI score and limb salvage (p<0.001): amputation occurred in 2.1% of patients with TOPI 4–5 and in 26.7% with TOPI 1–3.
Conclusion: The TOPI scale is a valid tool for objective assessment of revascularization effectiveness and outcome prediction in patients with acute lower limb ischemia following catheter-directed thrombolysis. A TOPI score ≥4 is associated with a high probability of limb salvage and may be used for risk stratification and optimization of treatment strategies.
Keywords: acute lower limb ischemia, catheter-directed thrombolysis, TOPI scale, angiographic assessment, revascularization, endovascular treatment, stenting, mechanical thrombaspiration, outcome prediction.
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