Clinical effect of wound depth in critical limb ischemia with tissue loss after endovascular treatment

Kobayashi, Noboru; Hirano, Keisuke; Ito, Yoshiaki; H, Ito; Yamawaki, Masahiro; Tsukahara, Reiko; Muramatsu, Toshiya

doi:10.1016/j.jvs.2015.06.230

Cited by 9 publications

(7 citation statements)

References 23 publications

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“…It is possible that this lack of a significant result in multivariate analysis may have been because of the smaller sample size. Nevertheless, grade 2 and grade 3 wounds had poorer wound healing rates compared with grade 1 wounds in this study, in accordance with the results of Kobayashi et al 11 More important, grade 3 wounds had poorer clinical outcomes compared with wounds with major tissue loss; 82.1% of UT grade 3 wounds failed to heal compared with 59.6% of major tissue loss wounds (P ¼ .03). The amputation and reintervention rates for grade 3 wounds did not differ significantly from those for major tissue loss wounds, although this apparent effect might have been associated with the smaller sample size.…”

Section: Discussionsupporting

confidence: 91%

“…Apart from the extent of the wound, wound depth has also been identified as an important factor predicting the outcome of EVT in CLI patients. 11 In this study, grade 3 wounds were an independent predictor of wound nonhealing according to multivariate analysis; although grade 2 wounds predicted wound nonhealing in univariate analysis, their predictive value was not demonstrated in multivariate analysis. It is possible that this lack of a significant result in multivariate analysis may have been because of the smaller sample size.…”

Section: Discussioncontrasting

confidence: 53%

“…Furthermore, only one study has reported on the importance of wound depth in CLI patients with tissue loss. 11 Notably, in the case of CLI, wound severity is usually assessed by Rutherford category, which is based solely on the extent of tissue loss and lacks information on wound depth. The University of Texas (UT) grade divides wound depth into three grades, and it was suggested that deep wounds are associated with a high rate of future amputation in patients with diabetic foot.…”

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confidence: 99%

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Predictors of delayed wound healing after successful isolated below-the-knee endovascular intervention in patients with ischemic foot ulcers

Das

2018

Journal of Vascular Surgery

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The general status of the patient and the target limb's condition are important predictors of wound nonhealing. Regarding the limb's condition, information on wound depth and duration in addition to wound extent and infection would further enable the selection of suitable CLI patients for EVT. Such information would also enable optimal wound management, leading to successful wound healing and improved limb salvage and survival rates.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 53%

mentioning

confidence: 99%

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Predictors of delayed wound healing after successful isolated below-the-knee endovascular intervention in patients with ischemic foot ulcers

Das

2018

Journal of Vascular Surgery

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“…In previous studies, factors such as diabetes mellitus, wound infection, low serum albumin, Rutherford category 6, indirect angiosome revascularisation, and wound depth had been independently associated with wound healing. 10,29,30 There may be concerns about potential damage causing loss of target vessels for bypass with interventions on pedal arteries. However, in the present study, only one patient with a failed PAR procedure required bypass surgery.…”

Section: Discussionmentioning

confidence: 99%

Editor's Choice – Impact of Endovascular Pedal Artery Revascularisation on Wound Healing in Patients With Critical Limb Ischaemia

Jung

Hong

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Pedal arch patency has been associated with improved wound healing after revascularisation. However, limited data exist regarding the impact of endovascular pedal artery revascularisation (PAR) on clinical outcomes of patients with critical limb ischaemia (CLI). This study demonstrates that successful PAR in patients with CLI achieved higher rates of wound healing and freedom from major amputation than infrapopliteal revascularisation without PAR. Thus, efforts should be made to revascularise the pedal arteries, especially when the pedal arch is completely absent in patients with CLI. Objective: The present study investigated the impact of endovascular pedal artery revascularisation (PAR) on the clinical outcomes of patients with critical limb ischaemia (CLI). Methods: This retrospective analysis of a single centre cohort included 239 patients who underwent endovascular revascularisation of infrapopliteal arteries for a chronic ischaemic wound. PAR was attempted in 141 patients during the procedure. After propensity score matching, there were 87 pairs of patients with and without PAR. Results: After the matching, the two groups showed balanced baseline clinical and lesion characteristics. PAR was achieved in 60.9% of the PAR group. Direct angiosome flow was more frequently obtained in the PAR group than in the non-PAR group (81.6% vs. 34.5%; p < .001). Subintimal angioplasty (47.1% vs. 29.9%; p ¼ .019) and pedaleplantar loop technique (18.4% vs. 0%; p < .001) were more frequent in the PAR group. At the one year follow up, the PAR group showed greater freedom from major amputation (96.3% vs. 84.2%; p ¼ .009). The wound healing rate, overall survival, major adverse limb event, and freedom from re-intervention did not differ significantly between the two groups. However, the patient subgroup with successful PAR showed a higher wound healing rate than the non-PAR group (76.0% vs. 67.0%; p ¼ .031). In a multivariable Cox proportional hazards regression model, successful PAR (hazard ratio [HR] 1.564, 95% confidence interval [CI] 1.068e2.290; p ¼ .022) was identified as an independent factor associated with improved wound healing, whereas gangrene (HR 0.659, 95% confidence interval [CI] 0.471e0.923; p ¼ .015), C reactive protein >3 mg/ dL (HR 0.591, 95% CI 0.386e0.904; p ¼ .015), and pre-procedural absence of pedal arch (HR 0.628, 95% CI 0.431e0.916; p ¼ .016) were associated with impaired wound healing. Conclusion: Successful PAR significantly improved wound healing in patients with CLI. Thus, efforts should be made to revascularise the pedal arteries, especially when the pedal arch is completely absent.

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“…Texas classification has been used for decades to describe the depth of the wound, and a recent study underlined that deep wounds were associated with a high rate of complicating infection, lower wound healing rate, and a longer time to wound healing. 14 Two years ago, Wound, Ischemia, and foot Infection (WIfI) classification was introduced and recommended to be used in patients with foot ulcer. The WIfI does not only grade wound depth but also the severity of ischemia and infection and thus predicts better the risk of amputation and need for revascularization.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Wound Healing Following Revascularization for Chronic Limb-Threatening Ischemia

Antonopoulos

Lazaris

Venermo

et al. 2019

Vasc Endovascular Surg

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Objectives: After surgical or endovascular revascularization, some ischemic lesions will not heal, while some others will heal at a variable period of time from the intervention, indicating a multifactorial interaction between local and systematic “wound healing–promoting” factors. Our objective was to identify predictors of wound healing following revascularization for chronic limb-threatening ischemia (CLTI). Methods: A literature review was performed to identify published research concerning clinical, biochemical, and noninvasive methods as predictors of wound healing time and wound-free period after surgical and endovascular revascularization for CLTI. Results: Our review indicated that potential predictors included local wound factors, wound depth, patient’s comorbidities, medications, smoking and alcohol abuse, poor vessel runoff, and direct versus indirect revascularization. Among the clinical biomarkers, platelet-derived growth factor, transforming growth factor β, basic fibroblast growth factor, tumor necrosis factor α, interleukin (IL) 1, and IL-6 have been proposed as potential predictors. Furthermore, the potential of noninvasive microcirculation assessment to predict proper wound healing has been the topic of extensive investigation. Among the novel methods, transcutaneous measurement of oxygen partial pressure, skin perfusion pressure, oxygen-to-see method, indocyanine green fluorescence imaging, and multispectral optoacoustic tomography have shown promising results. Conclusions: The risk factor profile of an ischemic lesion in the lower extremities with a delayed/failed healing response, following a successful revascularization, is not fully clarified. Although many predictors have been assessed so far, further research needs to be done to identify the optimal clinical and biochemical indices and the noninvasive technique assessing the microcirculation that is associated with complete wound healing.

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Clinical effect of wound depth in critical limb ischemia with tissue loss after endovascular treatment

Abstract: Wound depth is an important indicator of wound status and affects the clinical outcomes of CLI with tissue loss.

Cited by 9 publications

References 23 publications

Predictors of delayed wound healing after successful isolated below-the-knee endovascular intervention in patients with ischemic foot ulcers

Predictors of delayed wound healing after successful isolated below-the-knee endovascular intervention in patients with ischemic foot ulcers

Editor's Choice – Impact of Endovascular Pedal Artery Revascularisation on Wound Healing in Patients With Critical Limb Ischaemia

Predictors of Wound Healing Following Revascularization for Chronic Limb-Threatening Ischemia

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