Korean J Radiol.  2013 Jun;14(3):430-438. 10.3348/kjr.2013.14.3.430.

Endovascular Revascularization for Patients with Critical Limb Ischemia: Impact on Wound Healing and Long Term Clinical Results in 189 Limbs

• Bae JI
• Won JH
• Han SH
• Lim SH
• Hong YS
• Kim JY
• Kim JD
• Kim JS

• KMID: 1705455
• DOI: http://doi.org/10.3348/kjr.2013.14.3.430

Abstract

OBJECTIVE
To evaluate the impact on wound healing and long-term clinical outcomes of endovascular revascularization in patients with critical limb ischemia (CLI).
MATERIALS AND METHODS
This is a retrospective study on 189 limbs with CLI treated with endovascular revascularization between 2008 and 2010 and followed for a mean 21 months. Angiographic outcome was graded to technical success (TS), partial failure (PF) and complete technical failure. The impact on wound healing of revascularization was assessed with univariate analysis and multivariate logistic regression models. Analysis of long-term event-free limb survival, and limb salvage rate (LSR) was performed by Kaplan-Meier method.
RESULTS
TS was achieved in 89% of treated limbs, whereas PF and CF were achieved in 9% and 2% of the limbs, respectively. Major complications occurred in 6% of treated limbs. The 30-day mortality was 2%. Wound healing was successful in 85% and failed in 15%. Impact of angiographic outcome on wound healing was statistically significant. The event-free limb survival was 79.3% and 69.5% at 1- and 3-years, respectively. The LSR was 94.8% and 92.0% at 1- and 3-years, respectively.
CONCLUSION
Endovascular revascularization improve wound healing rate and provide good long-term LSRs in CLI.

Keyword

Critical limb ischemia; Infrapopliteal angioplasty; Diabetic foot

MeSH Terms

Adult
Aged
Aged, 80 and over
Analysis of Variance
Endovascular Procedures/adverse effects/*methods
Female
Foot/*blood supply
Humans
Ischemia/physiopathology/*surgery
Limb Salvage
Male
Middle Aged
Retrospective Studies
Risk Factors
Survival Rate
Treatment Outcome
Wound Healing/*physiology

Figure

• 

  Fig. 1 Technical success was obtained in 60-year-old male with Rutherford category 5 critical limb ischemia. A, B. Pre-procedural arteriography of infrapopliteal arteries. Origin of anterior tibial artery (ATA) (arrow) is seen. Posterior tibial artery is not seen. Peroneal artery (arrowheads) is patent. C. Non-healing wounds were gangrenes of 2nd and 4th toes of left foot. D. ATA was recanalized subintimally using 0.016 inch hydrophilic guide wire (arrows) with support of balloon catheter (arrowheads). E. After subintimally crossed wire reentered in distal dorsalis pedis artery (DPA). ATA was dilated with 2 mm and 2.5 mm balloon catheter (arrow). F, G. Recanalized ATA (arrows) and DPA (arrowhead) is evident. H. 2nd and 4th toe gangrenes healed completely 1 month after combined local wound care.

• 

  Fig. 2 Kaplan-Meier curve shows event-free survival of limbs after endovascular revascularization for critical limb ischemia. Probabilities of event free limb survival at 1 year and 3 years are 79.3% and 69.5%.

• 

  Fig. 3 Kaplan-Meier curves showing limb salvage rate (LSR) after endovascular revascularization (A) overall LSRs at 1 year and 3 years are 94.8% and 92% respectively. (B) Differences of LSR were statistically significant between technical success and technical failure group (p < 0.001), and between partial failure and technical failure groups (p < 0.001). TS = technical success, PF = partial failure, TF = technical failure

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