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

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.

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

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.

Abstract 14293: Time to Wound Healing and Major Adverse Limb Events in Patients With Critical Limb Ischemia Treated With Endovascular Therapy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Grant W Reed ◽  
Negar Salehi ◽  
Pejman Raeisi-Giglou ◽  
Umair Malik ◽  
Rami Kafa ◽  
...  
Keyword(s):  
Wound Healing ◽  
Endovascular Therapy ◽  
Critical Limb Ischemia ◽  
Proportional Hazards ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Cox Proportional Hazards ◽  
Time Dependent ◽  
Kaplan Meier

Introduction: There have been few studies evaluating the influence of time to wound healing on outcomes in patients with critical limb ischemia (CLI) after endovascular therapy. Methods: In this prospective study, patients with CLI treated with endovascular therapy were assessed for comorbidities, presence of wounds, wound healing, and major adverse limb events (MALE; major amputation, surgical endartectomy, or bypass) over time. The incidence of MALE was compared across patient and wound characteristics by Kaplan-Meier analysis. Associations between these variables and MALE were determined by Cox proportional hazards analysis. Results: A total of 252 consecutive patients with CLI were treated between November 1, 2011 and April 1, 2015; 179 (71%) had wounds, of which 97 (54%) healed. During median follow-up of 12.7 months (interquartile range 3.9 - 23.9 months), 46 (18%) had MALE. Wounds were associated with a greater risk of MALE (Hazard Ratio [HR] 3.5; 95% Confidence Interval [CI] 1.4-8.9; p=0.008). As a time-dependent covariate, wound healing was associated with less MALE (HR 0.23; 95% CI 0.10-0.53; p<0.001), and MALE was more frequent in patients with unhealed wounds (23% vs 11%; p<0.0001) (Figure - A). There was significantly less MALE in patients whose wounds healed within 4 months (24% vs 10%; p=0.032) (Figure - B), and less major amputation in those with healed wounds within 3 months (16% vs 5%; p=0.033). After multivariate adjustment for age, presence of diabetes, renal function, wound size, and procedural failure, independent predictors of MALE were wound healing as a time-dependent covariate (HR 0.18; 95% CI 0.08 - 0.40; p<0.0001), and creatinine ≥ 2 (HR 2.3; 95% CI 1.3-4.2; p=0.005). Conclusions: A shorter time to wound healing is associated with less MALE in patients with CLI after endovascular therapy. Efforts should be made to achieve wound healing as quickly as possible in this population, especially in those with renal dysfunction.

Treprostinil Sodium (Remodulin), a Prostacyclin Analog, in the Treatment of Critical Limb Ischemia: Open-Label Study

Vascular ◽  
2006 ◽  
Vol 14 (3) ◽  
pp. 142-148 ◽  
Author(s):  
Scott Berman ◽  
Rhonda Quick ◽  
Pam Yoder ◽  
Sonia Voigt ◽  
Deborah Strootman ◽  
...  
Keyword(s):  
Wound Healing ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Complete Healing ◽  
Rest Pain ◽  
Open Label ◽  
Serious Adverse Events ◽  
Peripheral Arterial ◽  
Prostacyclin Analog

The purpose of this study was to assess the safety of continuous subcutaneous therapy with treprostinil sodium (Remodulin), a prostacyclin analog, and its effect on ischemic rest pain and ischemic wound healing in subjects with critical limb ischemia (CLI) and no planned revascularization procedure. This was a 12-week, open-label, single-center pilot study enrolling 10 subjects (mean age 82.4 years) with Fontaine stage III to IV (Rutherford class 4–6) peripheral arterial disease and ankle brachial indices less than 0.55. The primary end point was safety, and the secondary end points were the effects of treatment on ischemic rest pain, limb salvage, and wound healing. There was a 62% reduction in mean worst rest pain and a 57% reduction in mean average rest pain at week 12, with most subjects using less pain medication. Three subjects experienced complete healing of their wounds. No subject developed a new wound during the trial. Treprostinil was generally well tolerated. Subcutaneous infusion-site pain was the most frequently reported side effect, with one subject withdrawing from the study as a result. Jaw pain was reported by two subjects. One subject experienced two serious adverse events considered unrelated to treprostinil (cholecystitis and congestive heart failure). This study demonstrates that chronic, continuous subcutaneous treprostinil is safe and can be useful in the treatment of ischemic pain and wounds in subjects with CLI. Future controlled studies are needed to evaluate these effects and determine appropriate patient selection.

Aggressive Wound Care by a Multidisciplinary Team Improves Wound Healing after Infrainguinal Bypass in Patients with Critical Limb Ischemia

2017 ◽  
Vol 41 ◽  
pp. 196-204 ◽  
Author(s):  
Shinsuke Mii ◽  
Kiyoshi Tanaka ◽  
Ryoichi Kyuragi ◽  
Hiroshi Ishimura ◽  
Shinsuke Yasukawa ◽  
...  
Keyword(s):  
Wound Healing ◽  
Critical Limb Ischemia ◽  
Multidisciplinary Team ◽  
Wound Care ◽  
Limb Ischemia ◽  
Infrainguinal Bypass
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