Wound healing and functional outcomes after infrainguinal bypass with reversed saphenous vein for critical limb ischemia

Abstract

Despite achieving the anticipated graft patency and limb salvage results, 25% of patients did not realize wound healing at 1 year of follow-up, 19% had lost ambulatory function, and 5% had lost independent living status. Prospective natural history studies are needed to further define the functional outcomes and their predictors after infrainguinal bypass for CLI.

Predictors of Delayed Wound Healing after Endovascular Therapy of Isolated Infrapopliteal Lesions Underlying Critical Limb Ischemia in Patients with High Prevalence of Diabetes Mellitus and Hemodialysis

“…4 In the management of CLI with tissue loss, delayed wound healing not only lowers QOL but also increases medical costs, even if limb loss is successfully prevented. 5,6 For BSX, reports have documented 1 year wound healing rates in the 74e85% range, and median wound healing time of 173e186 days post procedure 7,8 with regular dialysis, diabetes mellitus, low albumin level, non-ambulatory status, and Rutherford category 6 as predictors of delayed wound healing. 9 For EVT, the 1 year wound healing rate and median healing time were 54e86% and 97e145 days, respectively.…”

Psychological stress and wound healing in humans: A systematic review and meta-analysis

“…The recent utilization of wound healing as a primary outcome measure enables researchers to bridge this gap and investigate the impact of stress on an objective, concrete, and clinically relevant outcome, where the immune system plays a significant role [7]. Research investigating the determinants of wound healing has traditionally focused on clinical and biomedical factors (i.e., size of wound, dressing type, extent of pathology) associated with speed of healing [8][9][10]. However, recently the potential impact of psychosocial factors, including psychological stress, has been investigated.…”

Lower-extremity arterial revascularization: Is there any evidence for diabetic foot ulcer-healing?

“…All patients had PTA, and 983 patients (98.9%) had at least one open artery down to the foot. The 5-year primary patency was 88% (95% CI: 86-91%) [40]. Revascularization led to a significant increase in vascular parameters (ABI and TcPO 2 ), with only 34 (3.4%) cases of complications [13].…”

“…However, there are also substantial differences in healing time between neuropathic and ischaemic/neuroischaemic DFUs even after successful revascularization. In fact, healing rates are around 80% after 4 months of treatment in cases of neuropathy without PAD and only 40% after 6 months, whereas the rate is around 70% after 12 months with PAD, even with successful revascularization [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]71]. Thus, it is essential to look beyond macroangiopathy and the concept of vascular stenosis.…”