Wound treatment strategy based on multidisciplinary team approach for patients with critical limb ischemia

Ohura, Norihiko; Sakisaka, Masanobu; Sekiyama, Takuya; Matsubara, Hiroaki; Terabe, Yuta; Morishige, Yuki; Kinoshita, Mikio; Takushima, Akihiko

doi:10.7792/jlspm.10.52

Cited by 1 publication

(1 citation statement)

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“…Clinical guidelines on the management of peripheral artery disease, especially CLTI, have been published in rapid progression, providing systematic and practical strategies for managing CLTI 1-3, 13, 14) . Furthermore, the health insurance system in Japan has promoted the cooperation between dialysis centers and vascular specialists by reimbursing the relevant medical supervision charges since 2016 15) . The recent substantial increase in procedural volume 16) is likely the reflection in part of an expanded domestic capacity for lower extremity revascularization and in part of the increasing familiarity with CLTI.…”

Section: Discussionmentioning

confidence: 99%

Injury Precipitating Tissue Loss and Time to Referral to a Vascular Center in Patients with Chronic Limb-Threatening Ischemia

Takahara

Iida

Ohura

et al. 2023

JAT

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This study aimed to report injury precipitating tissue loss and to provide updated information on the time from tissue loss occurrence to referral to a vascular center for patients who developed chronic limb-threatening ischemia (CLTI) in Japan. Methods:We examined 450 patients who developed CLTI with tissue loss and were registered in a multicenter prospective study between October 2017 and June 2020. They were referred to the participating vascular centers for revascularization. Information on the injury precipitating tissue loss and time to referral was collected at registration. The severity of tissue loss was evaluated using the Wound, Ischemia, and foot Infection classification.Results: Injury precipitating tissue loss was absent in 52.0% (95% confidence interval, 47.3%-56.6%) of the patients. The absence was associated with lower albumin levels and preserved pressure sensation. Although the time to referral was significantly shorter in cases without a history of prereferral revascularization, 16.8% (12.8%-20.7%) of the patients were referred to the vascular centers more than 3 months after tissue loss occurrence. Time to referral, but not the lack of a clear precipitant for tissue loss, was significantly associated with the severity of tissue loss. Conclusion:A clear precipitant for tissue loss was often lacking, particularly in patients with low albumin levels and preserved pressure sensation. Delayed referral to a vascular center is still common.

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Section: Discussionmentioning

confidence: 99%