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

Das, Sushant Kumar; Yi, Yu; Li, Mao Quan

doi:10.1016/j.jvs.2017.08.077

Cited by 20 publications

(14 citation statements)

References 32 publications

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“…We identified 28 cohorts from 21 studies (in 23 publications) for inclusion in the review; together these report data on 38,604 participants. 4,6,13,17,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Some studies reported on more than one cohort (cohorts with different wound aetiologies or RCT treatment groups analysed as cohorts). These studies were identified from screening of 913 records following deduplication of the searches; we identified a further six studies from reference checking and assessed 272 studies as full text.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-two of the 28 cohorts included participants whose wounds had mixed infection status at baseline (some participants had infected wounds at baseline and some had non-infected wounds). 4,6,[31][32][33][34][35][36][37][38][39][40][41][42][43] This represents the overwhelming majority of participants (Figure 2(B)). Most cohorts of participants with mixed infection status wounds assessed the role of clinical infection (variously defined) as a prognostic factor for healing (Figure 3).…”

Section: Characteristics Of Cohortsmentioning

confidence: 99%

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Bacteria and bioburden and healing in complex wounds: A prognostic systematic review

Norman

Shi

Westby

et al. 2021

Wound Repair Regeneration

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The wound microbiome may play an important role in the wound healing process.We conducted the first systematic prognosis review investigating whether aspects of the wound microbiome are independent prognostic factors for the healing of complex wounds. We searched Medline, Embase, CINAHL and the Cochrane Library to February 2019. We included longitudinal studies which assessed the independent association of aspects of wound microbiome with healing of complex wounds while controlling for confounding factors. Two reviewers extracted data and assessed risk of bias and certainty of evidence using the GRADE approach. We synthesised studies narratively due to the clinical and methodological heterogeneity of included studies and sparse data. We identified 28 cohorts from 21 studies with a total of 38,604 participants, including people with diabetes and foot ulcers, open surgical wounds, venous leg ulcers and pressure ulcers. Risk of bias varied from low (2 cohorts) to high (17 cohorts); the great majority of participants were in cohorts at high risk of bias.Most evidence related to the association of baseline clinical wound infection with healing. Clinical infection at baseline may be associated with less likelihood of wound healing in foot ulcers in diabetes (HR from cohort with moderate risk of bias 0.53, 95% CI 0.33 to 0.83) or slower healing in open surgical wounds (HR 0.65, 95% CI 0.51 to 0.83); evidence in other wounds is more limited. Most other associations assessed showed no clear relationship with wound healing; evidence was limited and often sparse; and we documented gaps in the evidence. There is low certainty evidence that a diagnosis of wound infection may be prognostic of poorer healing in foot ulcers in diabetes, and some moderate certainty evidence for this in open surgical wounds. Low certainty evidence means that more research could change these findings.

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Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Cohortsmentioning

confidence: 99%

Bacteria and bioburden and healing in complex wounds: A prognostic systematic review

Norman

Shi

Westby

et al. 2021

Wound Repair Regeneration

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“…16 In the current study, plasma levels of NAP-2 were independently associated with CLI, but were not associated with T2DM. Diabetes delayed the healing of foot ulceration, 19,20 and CLI was the main causes for healing of lower limbs ulcers; 21,22 therefore, plasma NAP-2 levels not only may be a biomarker to predict the lower limb ischemia in the non-diabetic CLI population, but they also may be an ideal marker to predict the wound healing in diabetic CLI population.…”

Section: Discussionmentioning

confidence: 99%

Plasma NAP-2 levels are associated with critical limb ischemia in peripheral arterial disease patients

Wang

Gan

et al. 2019

Exp Biol Med (Maywood)

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Our study evaluates the relationship between plasma neutrophil-activating peptide-2 (NAP-2) levels and critical limb ischemia (CLI); 189 subjects were enrolled in this study: 59 subjects with CLI and type 2 diabetes mellitus (T2DM), 45 subjects with CLI and no T2DM, 43 patients with T2DM and no CLI, and 42 without both T2DM and CLI. Subjects with CLI had higher plasma levels of NAP-2 than those of the healthy group (2.04 ± 0.06 ng/mL vs. 1.75 ± 0.09 ng/mL, P = 0.011). Subjects with CLI and T2DM had higher plasma levels of NAP-2 than those of the T2DM group (2.08 ± 0.08 ng/mL vs. 1.73 ± 0.10 ng/mL, P = 0.007). However, subjects with CLI including CLI and T2DM+CLI had higher plasma levels of NAP-2 than those of the non-CLI group including healthy and T2DM group (2.06 ± 0.05 ng/mL vs. 1.74 ± 0.07 ng/mL, P < 0.001). The ankle brachial index (ABI) and total cholesterol (TC) were significantly and negatively correlated with plasma NAP-2 levels (rho = −0.250, P = 0.001; rho = −0.162, P = 0.026, respectively). Systolic blood pressure (SBP) positively correlated with plasma NAP-2 levels (rho = 0.187, P = 0.010). When adjusting for the factors, plasma NAP-2 levels were still significantly correlated with CLI (odds ratio = 11.543, 95% confidence intervals: 1.327–100.403, P = 0.027). The area under the curve (AUC) of NAP-2+confounders was 0.992 (95% confidence intervals 0.981 to 1.003, P < 0.001) and it was higher than those of NAP-2 alone (95% confidence intervals 0.241 to 0.407, P < 0.001) and confounders alone (AUC = 0.990, 95% confidence intervals −0.013 to 0.018, P = 0.797). In conclusion, elevated plasma NAP-2 was independently associated with CLI, but it was not correlated with T2DM. Plasma NAP-2 levels might be an early CLI diagnostic biomarker and might provide a novel target for CLI treatment. Impact statement Critical limb ischemia (CLI) is a serious arterial obstruction, resulting in serious reduction of blood flow to the extremities. CLI is a symptomatic disorder and is frequently not diagnosed in time. This results in a high mortality and elevated risk of limb amputation. Serum or plasma biomarkers play important roles in disease prevention, diagnosis, and prognosis. Elevated plasma neutrophil-activating peptide-2 (NAP-2) was found independently associated with CLI, but not with T2DM. Plasma NAP-2 levels might be an early CLI diagnostic biomarker and might provide a novel target for CLI treatment.

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“…A new analysis and review made by Das et al [83] in a 422 consecutive series of CLI patients, all treated by AC first-option strategy shows that beyond correct topographic foot flow reconstruction, the depths of ulcers, their duration, the albumin and the C-reactive protein levels, also the presence of local infection and gangrene represent independent factors to be carefully pondered in statistic evaluation [83]. Similar findings were reported by Lo et al [84] in another 809 patients analysis a few months ago.…”

Section: Current Literature Review Concerning Dr/wtr Strategiesmentioning

confidence: 99%

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

Alexandrescu¹,

Sinatra²,

Maufroy³

2019

WJCD

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Despite a lack of solid evidence in applying the angiosome concept (AC) in current chronic limb threatening ischemia (CLTI) treatment, several encouraging results for improved wound healing and less for limb preservation were reported in various consistency studies. Direct revascularization (DR) following the foot angiosomes distribution (whenever feasible) may afford better clinical results compared to angiosome indifferent, or indirect revascularization (IR), however without clear benefit on survival and for major adverse limb events (MALE). Inside this interrogation, the notable influence of the remnant collaterals, the foot arches, the wound characteristics, and the type of revascularization (bypass versus endovascular) still remain ardent topics. Current evidence suggests that applying DR in daily vascular practice requires practitioners to be committed to every individual hemodynamic variable in a thorough macro-and micro-vascular evaluation of the ischemic foot. It becomes clearer nowadays that not all CLTI foot ulcers hold same ischemic burden and seemingly need specific DR. In the same setting, a novel wound targeted revascularization (WTR) design was proposed assembling wider circulatory targets than genuine DR notion, as used by some authors. Beyond specific angiosomal artery reperfusion, WTR associates the available arches, the large-and medium-sized collaterals, and the arterial-arterial communicants, in an intentional "source artery" and "collateral" topographic foot revascularization. However, up to date, the notion of angiosome wound-guided revascularization (DR and WTR) detains only a reserved level of confirmation. As for DR, the WTR equally needs higher levels of evidence allowed by standardized definition, uniform indications, and pertinent results from multicenter larger prospective analysis, before large application.

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

Cited by 20 publications

References 32 publications

Bacteria and bioburden and healing in complex wounds: A prognostic systematic review

Bacteria and bioburden and healing in complex wounds: A prognostic systematic review

Plasma NAP-2 levels are associated with critical limb ischemia in peripheral arterial disease patients

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

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