Hiroyoshi Komai
Current Position
Professor of Vascular Surgery
Kansai Medical University Medical Center
Peripheral Artery Session

Topic: The challenge to the early detection of CLTI patients


Different bi-directional strategies are necessary for the optimal PAD treatment. Asymptomatic patients and claudicants should continue conservative treatment as possible. In contrast, CLTI patients should be performed immediate revascularization. It is important to detect the condition prior to CLTI for safe and effective revascularization aiming to limb salvage. We have been studying the differences between claudicants and CLI (CLTI) patients using various biomarkers and physiological tests to detect appropriate timing for revascularization. Our earlier study showed a decrease in vascular endothelium-dependent and independent dilatation as Fontaine's classification increased. Carnitine, a protein with an important role in energy metabolism within skeletal muscle, was found to have lower blood levels in patients with CLI. Osteopontin is a substance of which tissue concentration has been reported to be increased at atherosclerotic lesions. We found that blood osteopontin levels were significantly elevated in CLI. Lipid profile of PAD differs from that of other atherosclerotic diseases, with lower LDL cholesterol and triglycerides in the more severe cases. In particular, adiponectin, which is considered the good hormone against atherosclerosis, was found to be higher in bypass patients with a poorer long term survival rate, a result seeming contrary to the other reports. Our multicenter study showed that fewer patients on statins were in the CLI group, regardless of their lipid level. A good marker has not been found for years, but recently we developed a method to diagnose the severity of leg ischemia easily at the bedside with Perfusion Index (PI) of the toes using a transcutaneous oxygen saturation device. We have confirmed that patients tended not to progress to CLI when their PI was higher than cut-off value at least the following 3 months. We expect that the use of PI will allow earlier detection of severe ischemia, although needed further study.