Okazaki J, et al. - Authors here performed analysis of wound healing time and wound-free period as outcomes after surgical and endovascular revascularization for critical lower limb ischemia. Compared to surgical revascularization, endovascular therapy (EVT) revascularization seemed associated with longer wound healing time (WHT), reduced wound healing rate, and a shorter wound-free period (WFP). Wound, ischemia, and foot infection grade indicated an association with longer WHT and reduced wound healing rate, but not with a shorter WFP. Reduced wound healing rate and shorter WFP were evident with systemic conditions such as dialysis dependence, congestive heart failure, and being wheel chair bound, presumably because they limited life expectancy. They recognized WHT and WFP as useful criteria for evaluating limb outcomes in patients with critical limb ischemia.

Methods

• A retrospective review was performed of the medical records of patients developing lower critical limb ischemia with tissue loss who underwent surgical or endovascular revascularization of the infrainguinal vessels between 2009 and 2013.
• Authors analyzed the risk factors for achieving wound healing and Wound Recurrence and Amputation-free Survival (WRAFS) using Kaplan-Meier survival curves and Cox regression model.
• By the least squares method, they assessed risk factors to prolong wound healing time (WHT) and reduce WFP.

Results

• 278 limb revascularizations were performed on 233 patients; 138 endovascular and 140 surgical procedures were performed as first treatments.
• After primary revascularization,the proportion of healed wounds 1, 2, and 3 years was 64.0%, 69.7%, and 70.5%, respectively.
• An EVT-first strategy (risk ratio [RR], 2.47), congestive heart failure (RR, 2.05), and wound, ischemia, and foot infection wound grade (RR, 1.59) were identified as significant risk factors for wound healing.
• The mean WHT of 143.7 days was observed.
• Significantly longer WHT was observed with an EVT-first strategy and wound infection.
• The mean WFP of 711.0 days was evident.
• Significantly shorter WFPs seemed associated with an EVT-first strategy, history of coronary artery disease, and dialysis dependence.
• At 1 and 2 years after achievement of wound healing, WRAFS were 76.9% and 64.2%, respectively.
• In this study, relevant risk factors against WRAFS included a history of coronary artery disease (RR, 1.68), dialysis dependence (RR, 2.03), and being wheel chair bound (RR, 1.64).