Utility of the Small Artery Disease (SAD) score on lateral foot angiography in patients with chronic limb threatening ischemia.

PURPOSE: To evaluate the utility of the Small Artery Disease (SAD) score as a predictor of clinical outcomes and major adverse limb events in patients with chronic limb-threatening ischemia (CLTI), using lateral digital subtraction angiography images. MATERIALS AND METHODS: A retrospective study was conducted with 183 patients with Fontaine 3 or 4 (mean age 72,2 ± 12,1 years old, 132 male) that underwent lateral DSA of the foot between 2020 and 2022. Three independent observers assessed all lateral projections of the foot using the SAD score. Outcomes included wound healing, amputation, repeat revascularisation, major adverse limb events (MALE) and survival. RESULTS: Patients with a SAD score ≥1 had a significantly increased risk for MALE (HR 2,22, p = 0,011) and death (HR 2,06, p = 0,025). There was no significant risk for impaired wound healing (HR 1,15, p= 0,669) and amputation (HR 1,48, p = 0,157) in patients with SAD ≥ 1. Interobserver agreement between the three observers for presence of SAD was substantial with an intra-class correlation coefficient of 0,61 (95% CI 0,53-0,68). CONCLUSION: Presence of SAD increases the risk of MALE and death in patients with chronic limb-threatening ischemia (CLTI), but had no relation with wound healing or amputation.