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Poor inter-observer agreement in anatomical classifications of infrapopliteal arterial disease due to mandatory selection of only one target artery

Ludwigs, Karin ; Andersson, Manne ; Johnsson, Åse A ; Nordanstig, Joakim ; Svalkvist, Angelica ; Falkenberg, Mårten and Baubeta, Erik LU orcid (2023) In Acta radiologica (Stockholm, Sweden : 1987) 64(3). p.1298-1306
Abstract

BACKGROUND: Established anatomical classifications of infrapopliteal arterial lesion severity are based on assessment of only one target artery, not including all infrapopliteal arteries although multivessel revascularization is common.

PURPOSE: To investigate the reproducibility of one of these classifications and a new aggregated score.

MATERIAL AND METHODS: A total of 68 patients undergoing endovascular infrapopliteal revascularization at Sahlgrenska University Hospital during 2008-2016 were included. Preoperative magnetic resonance angiographies (MRA) and digital subtraction angiographies (DSA) were evaluated by three blinded observers in random order, using the infrapopliteal TransAtlantic Inter-Society Consensus (TASC)... (More)

BACKGROUND: Established anatomical classifications of infrapopliteal arterial lesion severity are based on assessment of only one target artery, not including all infrapopliteal arteries although multivessel revascularization is common.

PURPOSE: To investigate the reproducibility of one of these classifications and a new aggregated score.

MATERIAL AND METHODS: A total of 68 patients undergoing endovascular infrapopliteal revascularization at Sahlgrenska University Hospital during 2008-2016 were included. Preoperative magnetic resonance angiographies (MRA) and digital subtraction angiographies (DSA) were evaluated by three blinded observers in random order, using the infrapopliteal TransAtlantic Inter-Society Consensus (TASC) II classification. An aggregated score, the Infrapopliteal Total Atherosclerotic Burden (I-TAB) score, including all infrapopliteal arteries, was constructed and used for comparison.

RESULTS: Inter-observer agreement on lesion severity for each evaluated artery was good; Krippendorff's α for MRA 0.64-0.79 and DSA 0.66-0.84. Inter-observer agreement on TASC II grade, based on the selected target artery as stipulated, was poor; Krippendorff's α 0.14 (95% confidence interval [CI]=-0.05 to 0.30) for MRA and 0.48 (95% CI=0.33-0.61) for DSA. Inter-observer agreement for the new I-TAB score was good; Krippendorff's α 0.76 (95% CI=0.70-0.81) for MRA and 0.79 (95% CI=0.74-0.84) for DSA.

CONCLUSION: Reproducible assessment of infrapopliteal lesion severity can be achieved for separate arteries with both MRA and DSA using the TASC II definitions. However, poor inter-observer agreement in selecting the target artery results in low reproducibility of the overall infrapopliteal TASC II grade. An aggregated score, such as I-TAB, results in less variability and may provide a more robust evaluation tool of atherosclerotic disease severity.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta radiologica (Stockholm, Sweden : 1987)
volume
64
issue
3
pages
1298 - 1306
publisher
SAGE Publications
external identifiers
  • scopus:85131193932
  • pmid:35619547
ISSN
1600-0455
DOI
10.1177/02841851221102788
language
English
LU publication?
yes
id
56d8130a-88f1-4d06-af4e-b9942543bef6
date added to LUP
2022-07-25 10:41:01
date last changed
2024-08-05 11:52:58
@article{56d8130a-88f1-4d06-af4e-b9942543bef6,
  abstract     = {{<p>BACKGROUND: Established anatomical classifications of infrapopliteal arterial lesion severity are based on assessment of only one target artery, not including all infrapopliteal arteries although multivessel revascularization is common.</p><p>PURPOSE: To investigate the reproducibility of one of these classifications and a new aggregated score.</p><p>MATERIAL AND METHODS: A total of 68 patients undergoing endovascular infrapopliteal revascularization at Sahlgrenska University Hospital during 2008-2016 were included. Preoperative magnetic resonance angiographies (MRA) and digital subtraction angiographies (DSA) were evaluated by three blinded observers in random order, using the infrapopliteal TransAtlantic Inter-Society Consensus (TASC) II classification. An aggregated score, the Infrapopliteal Total Atherosclerotic Burden (I-TAB) score, including all infrapopliteal arteries, was constructed and used for comparison.</p><p>RESULTS: Inter-observer agreement on lesion severity for each evaluated artery was good; Krippendorff's α for MRA 0.64-0.79 and DSA 0.66-0.84. Inter-observer agreement on TASC II grade, based on the selected target artery as stipulated, was poor; Krippendorff's α 0.14 (95% confidence interval [CI]=-0.05 to 0.30) for MRA and 0.48 (95% CI=0.33-0.61) for DSA. Inter-observer agreement for the new I-TAB score was good; Krippendorff's α 0.76 (95% CI=0.70-0.81) for MRA and 0.79 (95% CI=0.74-0.84) for DSA.</p><p>CONCLUSION: Reproducible assessment of infrapopliteal lesion severity can be achieved for separate arteries with both MRA and DSA using the TASC II definitions. However, poor inter-observer agreement in selecting the target artery results in low reproducibility of the overall infrapopliteal TASC II grade. An aggregated score, such as I-TAB, results in less variability and may provide a more robust evaluation tool of atherosclerotic disease severity.</p>}},
  author       = {{Ludwigs, Karin and Andersson, Manne and Johnsson, Åse A and Nordanstig, Joakim and Svalkvist, Angelica and Falkenberg, Mårten and Baubeta, Erik}},
  issn         = {{1600-0455}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{1298--1306}},
  publisher    = {{SAGE Publications}},
  series       = {{Acta radiologica (Stockholm, Sweden : 1987)}},
  title        = {{Poor inter-observer agreement in anatomical classifications of infrapopliteal arterial disease due to mandatory selection of only one target artery}},
  url          = {{http://dx.doi.org/10.1177/02841851221102788}},
  doi          = {{10.1177/02841851221102788}},
  volume       = {{64}},
  year         = {{2023}},
}