Courtesy of Dr. Carlos Fava.
Delaying or failing to heal trophic wounds in critical limb ischemia (CLI) changes quality of life, delays rehabilitation and is associated to infections and amputation.
Pedal artery revascularization with angioplasty would speed up recovery and improve CLI wound healing.
The study analyzed 257 patients with de novo infrapopliteal lesions receiving PCI for CLI. 140 of these patients (54.5%) received pedal artery angioplasty (PAA).
Mean age was 73, all patients were in Rutherford class 5 or 6, and one third of patients presented >3 mg/dl creatinine. There were no differences in type, location depth or infection of trophic wounds.
Angiosome direct revascularization was successful in 60.3% of the population. In PAA patients, ankle brachial index (0.88 vs. 0.81; p=0.004) and skin perfusion pressure was higher (49.3 mmHg vs. 41.9 mmHg; p=0.02).
At one year follow up, limb salvage was 88.5% and amputation free survival rate was 73.5%. Wound resolution was 49.5%. In the moderate risk group, pedal artery revascularization saw better resolution of trophic wounds and better time to wound healing (59.3% vs. 38.1%; p=0.003 y 211 vs. 365 days; p=0.008).
Independent predictors of delayed healing were:
- non ambulatory status
- wound depth (UT ≥2)
- the need for hemodialysis
Conclusion
Patients receiving pedal artery angioplasty showed higher trophic wound healing and better time to healing. As regards wound healing, this aggressive strategy could become a salvage procedure for patients with CLI and pedal artery disease.
Editorial Comment
Critical Limb Ischemia is on the rise, and in this analysis, a more aggressive angioplasty procedure showed benefits, especially in high risk groups.
It is important to have programs for this group of patients and to familiarize with wound classification, depth and infection presence (UT and WIFI classifications) to be able to better assess strategies.
Courtesy of Dr. Carlos Fava. Favaloro Foundation, Buenos Aires, Argentina.
Original Title: Clinical Outcome of Pedal Artery Angioplasty for Patients with Ischemic Wounds
Results from the Multicenter RENDEZVOUZ Registry.
Reference: Tatsuya Nakama, et al. J Am Coll Cardiol Intv 2017;10:79-90.
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