Critical Limb Ischemia: Wound Blush Is the Most Important Objective

The aim of this study was to find the optimal angiographic endpoint for infrapopliteal interventions to be able to predict wound healing.

Evidence shows acceptable patency and successful limb salvage in patients with critical limb ischemia after infrapopliteal intervention. However, the optimal angiographic endpoint remains unclear. Is it enough to restore flow in one vessel or is it necessary to treat them all? And we should also consider the angiosome guided revascularization approach.

Several studies have been conducted to try answer the question of optimal infrapopliteal angioplasty enpoint in patients with critical limb ischemia. This is a subanalysis of the prospective multicenter registry OLIVE (Endovascular Treatment for Infrainguinal Vessels in Patients with Critical Limb Ischemia), that included patients with critical limb ischemia and infrainguinal disease.

Researchers analyzed 185 limbs with ischemic ulcers classified as Rutherford 5 or 6 undergoing endovascular treatment.

The association of final angiographic outcome and ulcer healing was done using the Cox model.

Wound healing rate was 73.5%. The probabilities of proper wound healing were significantly higher in patients with wound blush (79.6% vs. 46.5%; p = 0.01). Wound blush was an independent predictor of wound healing.

Conclusion

The presence of wound blush after infrapopliteal intervention was associated with wound healing. Wound blush could be a new angiographic predictor of success in patients with critical limb ischemia

Editorial Comment

This new concept complements the angiosome guided approach. In fact, successful angiosome revascularization and ulcer flow restoration may most likely produce wound blush. The benefit of this new concept is that it is far easier to assess in the cath lab and a lot easier to remember (compared to the angiosome), since it reminds us of the myocardial blush of primary PCI.

Original Title: Wound Blush Obtainment Is the Most Important Angiographic Endpoint for Wound Healing.

Reference: Makoto Utsunomiya et al. JACC Cardiovasc Interv. 2017 Jan 23;10(2):188-194.

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