Study Evaluates Impact of Endovascular Pedal Artery Revascularization on Wound Healing in Patients With CLI
October 21, 2019—A study investigating the impact of endovascular pedal artery revascularization (PAR) on the clinical outcomes of patients with critical limb ischemia (CLI) was published by Hae Won Jung, MD, et al online in European Journal of Vascular and Endovascular Surgery (EJVES).
This retrospective analysis of a single-center cohort included 239 patients who underwent endovascular revascularization of infrapopliteal arteries for a chronic ischemic wound. PAR was attempted in 141 patients during the procedure. After propensity score matching, there were 87 pairs of patients with and without PAR, advised the investigators. After matching, the two groups showed balanced baseline clinical and lesion characteristics.
As summarized in EJVES, PAR was achieved in 60.9% of the PAR group. Direct angiosome flow was more frequently obtained in the PAR group than in the non-PAR group (81.6% vs 34.5%; P < .001). Subintimal angioplasty (47.1% vs 29.9%; P = .019) and pedal-plantar loop technique (18.4% vs 0%; P < .001) were more frequent in the PAR group.
At 1-year follow-up, the PAR group showed greater freedom from major amputation (96.3% vs 84.2%; P = .009). The wound healing rate, overall survival, major adverse limb event, and freedom from reintervention rates did not differ significantly between the two groups. However, the patient subgroup with successful PAR showed a higher wound healing rate than the non-PAR group (76% vs 67%; P = .031).
In a multivariable Cox proportional hazards regression model, successful PAR (hazard ratio [HR], 1.564; 95% confidence interval [CI], 1.068–2.29; P = .022) was identified as an independent factor associated with improved wound healing.
The following were associated with impaired wound healing:
- Gangrene (HR, 0.659; 95% CI, 0.471–0.923; P = .015)
- C-reactive protein > 3 mg/dL (HR, 0.591; 95% CI, 0.386–0.904; P = .015)
- Preprocedural absence of pedal arch (HR, 0.628; 95% CI, 0.431–0.916; P= .016)
Successful PAR significantly improved wound healing in patients with CLI. Thus, efforts should be made to revascularize the pedal arteries, especially when the pedal arch is completely absent, concluded the investigators in EJVES.