Makoto Utsunomiya1, Mitsuyoshi Takahara2, Osamu Iida3, Yasutaka Yamauchi4, Daizo Kawasaki5, Yoshiaki Yokoi6, Yoshimistu Soga7, Norihiko Ohura8, Masato Nakamura9. 1. Division of Cardiovascular Medicine, Tokyo Rosai Hospital, Tokyo, Japan. Electronic address: m.utsu0705@gmail.com. 2. Department of Metabolic Medicine Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Diabetes Care Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan. 3. Cardiovascular Division, Kansai Rosai Hospital, Amagasaki, Japan. 4. Cardiovascular Center, Kikuna Memorial Hospital, Yokohama, Japan. 5. Cardiovascular Center, Morinomiya Hospital, Osaka, Japan. 6. Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan. 7. Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan. 8. Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, Mitaka, Japan. 9. Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan.
Abstract
OBJECTIVES: This study aimed to assess the optimal angiographic endpoint of endovascular therapy (EVT) for wound healing. BACKGROUND: Several reports have demonstrated acceptable patency and limb salvage rates following infrapopliteal interventions for the treatment of critical limb ischemia (CLI). However, the optimal angiographic endpoint of EVT remains unclear. METHODS: We conducted a subanalysis of the prospective multicenter OLIVE (Endovascular Treatment for Infrainguinal Vessels in Patients with Critical Limb Ischemia) registry investigation assessing patients who received infrainguinal EVT for CLI. We analyzed data from 185 limbs with ischemic ulcerations classified as Rutherford class 5 or 6, managed with EVT alone (i.e., not undergoing bypass surgery). The wound healing rate after EVT was estimated by the Kaplan-Meier method. The association between final angiographic data and wound healing was assessed employing a Cox proportional hazards model. RESULTS: The overall wound healing rate was 73.5%. The probabilities of wound healing in patients with wound blush obtainment was significantly higher than that of those without wound blush (79.6% vs. 46.5%; p = 0.01). In the multivariate analysis, wound blush obtainment was an independent predictor of wound healing. CONCLUSION: The presence of wound blush after EVT is significantly associated with wound healing. Wound blush as an angiographic endpoint for EVT may serve as a novel predictor of wound healing in patients with CLI.
OBJECTIVES: This study aimed to assess the optimal angiographic endpoint of endovascular therapy (EVT) for wound healing. BACKGROUND: Several reports have demonstrated acceptable patency and limb salvage rates following infrapopliteal interventions for the treatment of critical limb ischemia (CLI). However, the optimal angiographic endpoint of EVT remains unclear. METHODS: We conducted a subanalysis of the prospective multicenter OLIVE (Endovascular Treatment for Infrainguinal Vessels in Patients with Critical Limb Ischemia) registry investigation assessing patients who received infrainguinal EVT for CLI. We analyzed data from 185 limbs with ischemic ulcerations classified as Rutherford class 5 or 6, managed with EVT alone (i.e., not undergoing bypass surgery). The wound healing rate after EVT was estimated by the Kaplan-Meier method. The association between final angiographic data and wound healing was assessed employing a Cox proportional hazards model. RESULTS: The overall wound healing rate was 73.5%. The probabilities of wound healing in patients with wound blush obtainment was significantly higher than that of those without wound blush (79.6% vs. 46.5%; p = 0.01). In the multivariate analysis, wound blush obtainment was an independent predictor of wound healing. CONCLUSION: The presence of wound blush after EVT is significantly associated with wound healing. Wound blush as an angiographic endpoint for EVT may serve as a novel predictor of wound healing in patients with CLI.