TCT-526 The Impact of Wound Healing for Isolated Below the Knee Lesion Patients with Critical Limb Ischemia

Objectives: The aim of this study is to investigate the impact of tibial runoff on outcomes of femoropopliteal interventions for atherosclerotic lesions. Methods: A retrospective review of 243 endovascular procedures for femoropopliteal atherosclerotic lesions on 243 limbs of 197 patients was performed. Results: The distribution rates of good tibial runoff (runoff score <7) and poor tibial runoff (runoff score ≥7) were 37.0% and 63.0%, respectively. In the poor tibial runoff group, the patients were older ( P = .019), and the proportion of male was lower ( P = .014). There was a significantly higher proportion of rest pain or tissue loss ( P < .001), and the prevalence of stroke ( P = .031) and renal insufficiency ( P = .005) was significantly higher in the poor runoff group. After femoropopliteal intervention, the amputation-free survival ( P = .03) and freedom from ischemia ( P = .003) were significantly lower in the poor runoff group. The interventions targeting below-the-knee (BTK) lesions performed concomitantly for critical limb ischemia or tissue loss with poor tibial runoff did not show a significant advantage in terms of freedom from ischemia; however, minor trends of longer lasting freedom from ischemia were observed when BTK intervention was combined. Conclusion: The patients with poor runoff showed significantly lower amputation-free survival and freedom from ischemia. In poor tibial runoff limbs with critical limb ischemia or tissue loss, BTK intervention did not demonstrate additional significant beneficial outcomes; however, there was a minor trend of longer lasting freedom from ischemia after concomitant BTK intervention.

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Surgical Wound Healing After Below the Knee Bypass Surgery for Critical Limb Ischemia

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.1030 ◽

2019 ◽

Vol 58 (6) ◽

pp. e394-e395

Author(s):

Veikko Nikulainen ◽

Päivi Helmiö ◽

Harri Hakovirta

Keyword(s):

Wound Healing ◽

Critical Limb Ischemia ◽

Bypass Surgery ◽

Limb Ischemia ◽

Surgical Wound ◽

Below The Knee

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The Impact of Decline in Activities of Daily Living (ADL) of Patients With Critical Limb Ischemia (CLI) After Endovascular Treatment

Vascular and Endovascular Surgery ◽

10.1177/1538574418770849 ◽

2018 ◽

Vol 52 (6) ◽

pp. 411-417 ◽

Cited By ~ 1

Author(s):

Takahiro Tokuda ◽

Keisuke Hirano ◽

Masahiro Yamawaki ◽

Motoharu Araki ◽

Norihiro Kobayashi ◽

...

Keyword(s):

Wound Healing ◽

Activities Of Daily Living ◽

Endovascular Treatment ◽

Clinical Outcomes ◽

Critical Limb Ischemia ◽

Daily Living ◽

Independent Predictor ◽

Limb Ischemia ◽

Free Survival ◽

The Impact

Background: Certain patients with critical limb ischemia (CLI) experience significant decline in activities of daily living (ADL) during hospitalization. The prognosis of decline in ADL during hospitalization remains unknown. Methods: A retrospective analysis was performed on collected data of patients with CLI treated by endovascular treatment between April 2007 and December 2015. We evaluated CLI in patients ADL at the time of hospitalization and after discharge using the Barthel index. We classified all patients into patients with decline in ADL and stable in ADL and compared clinical outcomes (cumulative incidence of wound healing, amputation-free survival at 1 year) between the 2 groups. Results: Two hundred and fifty-five consecutive patients with CLI (221 limbs), who underwent successful endovascular intervention, were enrolled in this study. Of all patients, 22 patients were classified into the decline group. The prevalence of wound, Ischemia, foot infection (WIfI) classification high grade was higher in the decline group (30.7% vs 63.6%; P < .01). The wound healing rates were worse in the decline group than in the stable group (40% vs 78% at 1 year; P < .01). The same trends were observed in the amputation-free survival (37% vs 78%; P < .01). After multivariate analysis, decline in ADL was an independent predictor of wound healing and amputation-free survival (odds ratio [OR]: 2.85, 95% confidence interval [CI]: 1.61-3.35, P < .01; OR: 2.46, 95% CI: 1.26-4.53, P = .01). Conclusions: Patients with CLI with decline in ADL during hospitalization were found to have a poor prognosis suggesting that a decline in ADL may affect the clinical outcomes.

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Impact of endovascular pedal arteries revascularization on wound healing in patients with critical limb ischemia

International Surgery Journal ◽

10.18203/2349-2902.isj20204663 ◽

2020 ◽

Vol 7 (11) ◽

pp. 3633

Author(s):

Mohamed M. El Yamany ◽

Hatem M. Mohamed ◽

Meera R. Boulos ◽

Sherif A. Raffat

Keyword(s):

Wound Healing ◽

Critical Limb Ischemia ◽

Wound Care ◽

Limb Ischemia ◽

Arterial Disease ◽

University Hospital ◽

Endovascular Revascularization ◽

Time Required ◽

The Impact

Background: Critical limb ischemia (CLI) is the final consequence of peripheral arterial disease (PAD). The management of this complex patient population often warrants a multidisciplinary approach with collaboration between endovascular interventionist, vascular surgeons, podiatrist, infectious disease, and wound care specialist. Objective of the study was to evaluate the impact of endovascular pedal arteries revascularization on wound healing in patients with critical limb ischemia.Methods: This was an interventional study conducted on 30 consecutive CLI patients underwent infra-genicular endovascular revascularization who attended to the outpatient department and emergency, Suez Canal university hospital complaining of symptoms of critical lower limb ischemia involving the foot (rest pain, ulcer and gangrene), during the period study from June 2017 till January 2019. Full detailed history, full examination, lab investigation, radiological imaging was done.Results: The pain intensity decreased from 7 to 4 post-procedural at 2nd day post-op, then to 3 at one week follow up and then it totally disappeared at one month follow up visit. The remaining patients who had incomplete PAA reported faster relieve of pain and more dramatic improve over time as it was totally relieved post procedural by time of discharge. The overall mean time required to achieve wound healing was 15±8 weeks.Conclusion: Successful pedal artery revascularization significantly improved wound healing in patients with CLI. Endovascular revascularization is effective to facilitate healing of wounds in CLI and can be performed without significant complications.

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Hybrid Foot Vein Arterialization in No-Option Patients With Critical Limb Ischemia: A Preliminary Report

Journal of Endovascular Therapy ◽

10.1177/1526602818820792 ◽

2018 ◽

Vol 26 (1) ◽

pp. 7-17 ◽

Cited By ~ 9

Author(s):

Roberto Ferraresi ◽

Andrea Casini ◽

Fabrizio Losurdo ◽

Maurizio Caminiti ◽

Alessandro Ucci ◽

...

Keyword(s):

Wound Healing ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Major Amputation ◽

Below The Knee ◽

Surgical Bypass ◽

Foot Lesions ◽

Wound Classification ◽

Grade 3

Purpose: To describe a preliminary experience in treating no-option critical limb ischemia (CLI) patients with a hybrid foot vein arterialization (HFVA) technique combining open plus endovascular approaches. Materials and Methods: Between May 2016 and January 2018, 35 consecutive patients (mean age 68±12 years; 28 men) with 36 no-option CLI limbs underwent HFVA in our center. All limbs had grade 3 WIfI (Wound, Ischemia, and foot Infection) ischemia, and the wound classification was grade 1 in 4 (11%) limbs, grade 2 in 4 (11%), and grade 3 in 28 (78%). Surgical bypass was done on the medial marginal vein or a posterior tibial vein, followed by endovascular removal of foot vein valves and embolization of foot vein collaterals. A “tension-free” surgical approach was used to treat foot lesions. Results: At a mean follow-up of 10.8±2 months, limb salvage was achieved in 25 (69%) limbs and wound healing in 16 (44%); 9 patients presented an unhealed wound. Eleven (31%) patients underwent a major amputation (2 below the knee and 9 thigh). One patient with an unhealed wound and open bypass died of myocardial infarction. Conclusion: HFVA is a promising technique able to achieve acceptable rates of limb salvage and wound healing in no-option patients generally considered candidates for an impending major amputation. Further studies are needed to standardize the technique and better identify patients who can benefit from this approach.

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