Ulcer Healing After Peripheral Intervention

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp panied by an increase in renal diseases, and the incidence of peripheral arterial disease (PAD) among dialysis patients is also increasing. In Japan, 50% of CLI patients have endstage renal disease (ESRD). 7 Furthermore, populations are aging rapidly in advanced countries; in other words, disease duration is increasing among DM and ESRD patients, in turn, increasing the risk of triggering and advancing arterial diseases. In this patient group, vascular disease is also accompanied by microangiopathy, which causes CLI with tissue loss.Analysis of the factors that impair the ulcer healing process in highly heterogeneous CLI patient groups is complicated. To establish a revascularization strategy after properly determining the healing vs. impairing factors, it is essential to gather ample data on post-revascularization ulcer healing. However, such reports are few, and even the guidelines do not provide revascularization procedural options from the viewpoint of ulcer healing.This review organized the reported factors that impair ulcer healing and identified those that clearly have a major effect on revascularization outcome and limb prognosis. We highlight the factors that are useful in planning revascularization strategies from the viewpoint of ulcer healing. dvancements in endovascular treatment (EVT) for critical limb ischemia (CLI) have enabled vascular surgeons, cardiologists and radiologists to participate in revascularization procedures. However, the number of experts in post-revascularization ulcer management has not caught up with the increasing number of revascularization procedures. Moreover, both education and knowledge regarding ulcer healing are insufficient for physicians performing revascularization. The treatment guideline for diabetic foot ulcers is well-established, 1 but evidence supporting strategies for the complete healing of ischemic ulcers after revascularization remains scant.Among the many studies that have reported limb salvage, complete ulcer healing was reported in only 17 studies (0.9%) according to a literature search from 1985 to 2005. 2 However, ulcer healing after revascularization is a major concern among patients, and the expected healing period is important in terms of health economics and the patient's quality of life (QOL). 3,4 Furthermore, information clarifying stubborn ulcers is meaningful for preventing the onset of ulcers and to educate the medical personnel who may potentially make an early discovery of such ulcers.In particular, there has been a tremendous worldwide increase in the number of patients with diabetes mellitus (DM) and the percentage of CLI patients with DM is increasing markedly, currently accounting for 70%. 5, 6 The increase in DM is accom- Complete ulcer healing is one of the most important goals of treatment for critical limb ischemia; however, it is still difficult to inform patients of the time to ulcer healing before performing revascularization. The tim...

Analysis/Spectrum of admitted cases of lower extremity arterial disease (LEAD) in University Hospital of Nepal

“…38 A study by Kobayashi et al in 177 individuals found wound location most commonly at toe followed by Heel. 39,40 Heel and extensive wounds were found difficult to heal. 39,40 Further, delayed heel ulcer are directly linked to major amputation.…”

Outcome after Hybrid Outflow Interventions for Chronic Limb-threatening Ischemia

“…Okazaki et al (25) published their results after surgical or endovascular revascularization of ischemic limbs: 64% ulcer healing at 12 months and their median ulcer healing time was 144 days. Azuma et al (26) published in 2014 a thorough review of the literature on ulcer healing after revascularization. Among the many studies reporting limb salvage, they found only 17 (0.1%) reporting data on wound healing.…”

“…Among the many studies reporting limb salvage, they found only 17 (0.1%) reporting data on wound healing. In these, 1-year wound healing rates vary between 47% and 87%, we calculated the weighted median healing time of them to be 186 days ranging from 64 to 267 days (26). wound healing is dependent on several factors including patient comorbidities and local ulcer factors as depth, size, localization, and presence of infection.…”

Successful limb salvage through staged bypass combined with free gracilis muscle transfer for critical limb ischemia with osteomyelitis after failed endovascular therapy

“…Reconstruction of soft tissue defects in the presence of chronic osteomyelitis remains difficult [11]. Even successful arterial reconstruction and free flap transfer does not necessarily guarantee the salvage of legs with extensive osteomyelitis [12], and adequate wound debridement and strict control of infection are prerequisites for the successful free flap insertion, prevention of infection recurrence, and subsequent amputation [10, 13].…”