Endovascular Revascularization for Patients with Critical Limb Ischemia: Impact on Wound Healing and Long Term Clinical Results in 189 Limbs

Abstract

ObjectiveTo evaluate the impact on wound healing and long-term clinical outcomes of endovascular revascularization in patients with critical limb ischemia (CLI).Materials and MethodsThis is a retrospective study on 189 limbs with CLI treated with endovascular revascularization between 2008 and 2010 and followed for a mean 21 months. Angiographic outcome was graded to technical success (TS), partial failure (PF) and complete technical failure. The impact on wound healing of revascularization was assessed with univariate analysis and multivariate logistic regression models. Analysis of long-term event-free limb survival, and limb salvage rate (LSR) was performed by Kaplan-Meier method.ResultsTS was achieved in 89% of treated limbs, whereas PF and CF were achieved in 9% and 2% of the limbs, respectively. Major complications occurred in 6% of treated limbs. The 30-day mortality was 2%. Wound healing was successful in 85% and failed in 15%. Impact of angiographic outcome on wound healing was statistically significant. The event-free limb survival was 79.3% and 69.5% at 1- and 3-years, respectively. The LSR was 94.8% and 92.0% at 1- and 3-years, respectively.ConclusionEndovascular revascularization improve wound healing rate and provide good long-term LSRs in CLI.

Impaired wound healing: facts and hypotheses for multi-professional considerations in predictive, preventive and personalised medicine

“…For example, critical limb ischemia (CLI) is characterised by non-healing ulcerations [112]. However, well-targeted preventive procedures such as endovascular revascularisation capable of restoring the blood supply to the tissue have been shown to be effective for improving the wound healing quality [113].…”

Effectiveness of Balloon Angioplasty and Stent Angioplasty: Wound Healing in Critically Limb Ischemic

“…1 The high prevalence in femoral and popliteal arteries might be caused by a chronic narrowing in diabetes mellitus or lousy lifestyle. 20 The incidence of diabetes mellitus in our subjects was quite high, which could explain the possible chronic vessel narrowing. The anatomical site in which the popliteal artery was compressed in joint articulation might also play a role.…”

“…Another study also stated that stent placement into a vessel had good patency and no re-obstruction noted after 24 months of intervention. 20 Stent angioplasty could be used in small vessels if balloon angioplasty failed. The efficacy of stent angioplasty in sub-intimal recanalization and calcification was limited.…”

“…The minus side of stent angioplasty was the anatomical restriction and risk of stent fracture, which might cause re-stenosis and re-occlusion. 20 Risk factors of stent fracture were stent type, length, and number. Balloon angioplasty could be done for a vessel less than 2 mm in diameter, a type of vessel that cannot be done by stent angioplasty.…”

Clinical outcome of angiosome-oriented infrapopliteal percutaneous transluminal angioplasty for isolated infrapopliteal lesions in patients with critical limb ischemia

“…In Korea, Bae et al (23) analyzed 205 cases of endovascular recanalization for chronic severe critical limb ischemia and reported a technical success rate of 85%, major amputation rate of 2%, one-year limb salvage rate of 94.8%, and three-year limb salvage rate of 92.0%. Their limb salvage rate was >90% after appropriate IP-PTA, which emphasizes the importance of recanalization of at least one infrapopliteal artery that supplies blood directly to the lesion.…”