Wound healing of critical limb ischemia with tissue loss in patients on hemodialysis

We assessed wound healing in patients on hemodialysis (HD) with critical limb ischemia (CLI). This study enrolled 267 patients (including 120 patients on HD and 147 patients not on HD) who underwent endovascular therapy (EVT) for CLI. The primary endpoint was wound-healing rate at two years. Secondary endpoints were time to wound healing, wound recurrence rate, and limb salvage at two years. The percentage of male and young patients was higher in the HD patients ( p < 0.01). A lower patency of the pedal arch after EVT was observed frequently in HD patients ( p < 0.01). The wound-healing rate was significantly lower in HD patients (79.5% vs. 92.4%, p < 0.001). Time to wound healing was significantly longer in HD patients (median 132 days vs. 82 days, p = 0.005). Wound recurrence was observed more frequently in HD patients (25.0% vs. 10.2%, p = 0.007). Limb salvage (72.8% vs. 86.4%, p = 0.002) was significantly lower in HD patients. In a cox proportional hazard model, HD was an independent predictor of wound healing (risk ratio (RR), 0.46; 95% confidence interval (CI), 0.33–0.62; p < 0.001) and wound recurrence (RR, 1.58; 95% CI, 1.11–2.22; p = 0.01). HD was independently associated with lower and delayed wound healing, and wound recurrence.

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P4711The prognostic impact of infrapopliteal arterial calcification on wound healing in patients with critical limb ischemia

European Heart Journal ◽

10.1093/eurheartj/ehz745.1092 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y Hata ◽

O Iida ◽

M Asai ◽

M Masuda ◽

S Okamoto ◽

...

Keyword(s):

Wound Healing ◽

Critical Limb Ischemia ◽

Healing Rate ◽

Limb Ischemia ◽

Cox Proportional Hazards ◽

Tissue Loss ◽

Arterial Calcification ◽

Prognostic Impact ◽

Ambulatory Status ◽

Wound Healing Rate

Abstract Background Critical limb ischemia (CLI) is the most progressed manifestation of peripheral artery disease. Although patients with CLI commonly complicate with severely calcified lesions in infrapopliteal lesions, the prognostic impact of infrapopliteal arterial calcification on wound healing in patients with CLI has not been systematically studied. Purpose The aim of current study was to elucidate the prognostic impact of infrapopliteal arterial calcification on wound healing in CLI undergoing endovascular therapy (EVT). Methods This study enrolled 639 CLI patients with tissue loss (age 74±10 years, male 62%, diabetes 69%, hemodialysis 57%, Rutherford class 5 77%, class 6 23%) primarily treated with EVT for the infrapopliteal lesions between April 2010 and December 2015. Arterial calcification was assessed by high intensity fluoroscopy and classified into 3 groups as follows; 1) none, 2) unilateral and 3) bilateral calcification. The primary outcome measure was complete wound healing. The predictors of the outcome were evaluated by Cox proportional hazards regression analysis. Results During a mean follow-up period of 22±19 months, 1-year wound healing rate were 59.0%. In Kaplan-Meier analysis, 1-year wound healing rate was worse in patients with bilateral calcification than in those with unilateral or none calcification (Figure, 46.2% versus 55.1% versus 67.8%, P<0.001). After multivariate analysis, the predictors of wound healing were non-ambulatory status (hazard ratio (HR) 0.67 [95% confidential interval (CI) 0.53–0.85], P=0.001) and bilateral calcification (HR 0.75 [95% CI 0.47–0.98], versus none or unilateral calcification, P=0.036). Figure 1 Conclusion Infrapopliteal Arterial calcification as well as non-ambulatory status was associated with wound healing in patients with CLI.

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COMPARISON OF WOUND HEALING RATE AND TIME TO COMPLETE WOUND HEALING ACCORDING TO WOUND LOCATION IN CRITICAL LIMB ISCHEMIA

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)62105-1 ◽

2013 ◽

Vol 61 (10) ◽

pp. E2105

Author(s):

Norihiro Kobayashi ◽

Muramatsu Toshiya ◽

Tsukahara Reiko ◽

Ito Yoshiaki ◽

Hirano Keisuke

Keyword(s):

Wound Healing ◽

Critical Limb Ischemia ◽

Healing Rate ◽

Limb Ischemia ◽

Complete Wound Healing ◽

Wound Healing Rate

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Endovascular revascularization of multilevel arterial disease in patients with critical limb ischemia

International Surgery Journal ◽

10.18203/2349-2902.isj20182025 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2039

Author(s):

Asser Abd El Hamid Goda

Keyword(s):

Wound Healing ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Healing Rate ◽

Limb Ischemia ◽

Arterial Disease ◽

Endovascular Revascularization ◽

The Mean ◽

Revascularization Procedures ◽

Salvage Rate

Background: Critical limb ischemia (CLI) occurs due to progressive obstructive nature of atherosclerosis disease. Nowadays, there is widespread use of endovascular revascularization procedures for restoration of blood flow in CLI. The aim this study is evaluation of the efficacy of endovascular intervention for multilevel arterial disease in patients with critical limb ischemia.Methods: This prospective study was included CLI patients due to multilevel arterial disease who underwent endovascular revascularization between January 2016 and January 2017 in our institution. Study end points were limb salvage and wound healing. Results: The mean age of patients was (61.7±7.47) years, with 13 (61.9%) men. Eight limbs were identified as Rutherford category 4 (38.1%), ten limbs as Rutherford category 5 (47.6%), and three limbs as Rutherford category 6 (14.3%). Limb salvage rate was (90.5%) at 1 year. Wound healing rate was 80.9%.Conclusions: This study proved that endovascular revascularization of multilevel arterial disease for patients with critical limb ischemia is effective.

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Evaluation of Tissue Perfusion by Wound Blush and 2D Color-Coded Digital Subtraction Angiography During Endovascular Intervention and Its Impact on Limb Salvage in Critical Limb Ischemia

Journal of Endovascular Therapy ◽

10.1177/15266028211065957 ◽

2021 ◽

pp. 152660282110659

Author(s):

Hassan Lotfy ◽

Ahmed Abou El-Nadar ◽

Wael Shaalan ◽

Ali El Emam ◽

Akram Ibrahim ◽

...

Keyword(s):

Wound Healing ◽

Digital Subtraction Angiography ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Tissue Perfusion ◽

Technical Failure ◽

Digital Subtraction ◽

Reliable Technique ◽

Significant Difference

Purpose: Critical limb ischemia (CLI) is an entity with high mortality if not properly treated. The primary aim of CLI revascularization is to enhance wound healing, which greatly depends on microvascular circulation. The available tools for assessment of revascularization success are deficient in the evaluation of local microvascular tissue perfusion, that wound blush (WB) reflects. A reliable technique that assesses capillary flow to foot lesions is needed. This study aims to assess WB angiographically at sites of interest in the foot after revascularization and its impact on limb salvage in CLI. Materials and Methods: 198 CLI patients (Rutherford category 5/6) with infrainguinal atherosclerotic lesions amenable for endovascular revascularization (EVR) were included. Limbs were directly or indirectly revascularized by EVR. Direct revascularization meant that successful revascularization of the area of interest according to the angiosome concept was achieved. A completion angiographic run was taken to assess WB. Patients were divided into 2 groups; positive and negative WB groups. In the event of a disagreement between the observational investigators, the digital subtraction angiography (DSA) series was analyzed for hemodynamic changes with a computerized 2D color-coded DSA (Syngo iFlow). Results: 176 limbs had successful revascularization in 157 patients. The successful revascularization rate was 88.9% (176/198), with technical failure encountered in 22 limbs. 121 patients had positive WB and 55 patients had negative WB. Direct revascularization of target areas was obtained in 98 limbs (55.7%). There was a significant difference in the rate of achieving direct flow to the lesion between the positive WB and negative WB groups (36.4% vs 19.3%, p≤0.001). We noticed a nonsignificant difference between patients who had direct revascularization of the foot lesion(s) and those who had indirect revascularization as regards limb salvage. Patients were followed up for 25.2 ± 12.7 months. By the end of the first year, limb salvage rate was significantly higher in patients who had positive WB (98% vs 63%, p<0.001, after 2 years (97% vs 58%, p<0.001) and after 3 years (94% vs 51.5%, p<0.001). Conclusions: WB is an important predictor and a prognostic factor for wound healing in CLI patients with soft tissue lesions.

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Poor survival of dialysis patients with unhealed wounds because of critical limb ischemia: Limb salvage and survival requires wound healing

International Wound Journal ◽

10.1111/iwj.13162 ◽

2019 ◽

Vol 16 (5) ◽

pp. 1112-1118

Author(s):

Hisao Yoshikawa ◽

Shingo Kujime ◽

Masaki Iwasaki ◽

Masao Yoshikawa

Keyword(s):

Wound Healing ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Dialysis Patients ◽

Poor Survival

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Endovascular reconstruction of popliteal and infrapopliteal arteries for limb salvage and wound healing in patients with critical limb ischemia – A retrospective analysis

Indian Heart Journal ◽

10.1016/j.ihj.2015.07.024 ◽

2016 ◽

Vol 68 (1) ◽

pp. 77-82 ◽

Cited By ~ 4

Author(s):

Uday B. Khanolkar ◽

Biju Ephrem

Keyword(s):

Wound Healing ◽

Retrospective Analysis ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Infrapopliteal Arteries

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TCTAP A-099 Predictors of Wound Healing in Patients with Critical Limb Ischemia with Tissue Loss Following Successful Endovascular Treatment

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2014.02.119 ◽

2014 ◽

Vol 63 (12) ◽

pp. S28

Author(s):

Norihiro Kobayashi ◽

Toshiya Muramatsu ◽

Reiko Tsukahara ◽

Yoshiaki Ito ◽

Hiroshi Ishimori ◽

...

Keyword(s):

Wound Healing ◽

Endovascular Treatment ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Tissue Loss

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Surgical Revascularization in Patients with End-Stage Renal Disease: Results Using a New Paradigm in Outcomes Assessment

The American Surgeon ◽

10.1177/000313480707300612 ◽

2007 ◽

Vol 73 (6) ◽

pp. 598-605

Author(s):

Wesley B. Jones ◽

David L. Cull ◽

Corey A. Kalbaugh ◽

Anna L. Cass ◽

Spence M. Taylor

Keyword(s):

Wound Healing ◽

Renal Disease ◽

Limb Salvage ◽

Critical Limb Ischemia ◽

End Stage Renal Disease ◽

Limb Ischemia ◽

Graft Patency ◽

Surgical Revascularization ◽

Stage Renal Disease ◽

End Stage

Studies evaluating the outcome of surgical revascularization (SR) for critical limb ischemia in patients who have end-stage renal disease (ESRD) have differed widely in their findings and conclusions. Differences in definitions of success are largely responsible for the varying outcomes. We developed a method of outcomes assessment that incorporates four all-inclusive end-points to define success. These include primary graft patency to the point of wound healing, postoperative survival of at least 6 months, limb salvage of at least 1 year, and maintenance of ambulatory status of at least 6 months. The purpose of this study was to use this novel method of defining success to determine the outcome of SR in patients with ESRD. From 1998 to 2004, 40 patients (52 limbs) with ESRD and tissue loss underwent SR for limb salvage. Secondary graft patency and limb salvage rates at 36 months were 54.7 per cent and 53 per cent, respectively. When considering each of the four components used to define success separately, success encouragingly ranged between 60 per cent (patent graft until wound healing) and 87.5 per cent (survival for 6 months). However, if all parameters were combined, clinical success was achieved in only 40 per cent (16/40) of patients. Coronary artery disease was the only factor found to significantly reduce success ( P = 0.04). In conclusion, using this multiparameter definition of success, which combines four rather modest outcome milestones, favorable outcome occurred in the minority of cases. This study challenges our current method of analyzing success and questions our therapeutic approach to patients with critical limb ischemia and ESRD.

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