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Wound blush appears predictive of wound healing in endovascular therapy for CLI
In patients undergoing endovascular therapy for the treatment of critical limb ischemia, the presence of wound blush appears to be significantly correlated with wound healing, and may represent an important new predictor of wound healing in patients with critical limb ischemia, according to recent findings.
The study was a subanalysis of the OLIVE registry, a prospective, multicenter investigation evaluating patients who underwent infrainguinal endovascular therapy for CLI. The researchers assessed data on 185 limbs of 185 patients (mean age, 73 years; 67% men) with Rutherford class 5 or 6 ischemic ulcerations that were treated with endovascular therapy alone, without bypass surgery. The researchers used the Kaplan-Meier method to determine the wound healing rate after endovascular therapy. They used a Cox proportional hazards model to analyze the relationship between final angiographic findings and wound healing.
The researchers found that 142 patients (76%) had positive wound blush and 43 patients (23%) had negative wound blush.
The overall wound healing rate was 73.5%. Kaplan-Meier analysis revealed that the ulcer healing rate was lower in patients with negative wound blush (46.5%) vs. those with positive wound blush (79.6%; P = .01). Multivariate analysis adjusted for severity of CLI in the lower limbs found that wound blush was still an independent predictor of ulcer healing.
In a related editorial, Andrew J.P. Klein, MD, from the department of interventional cardiology, vascular and endovascular medicine at Piedmont Heart Institute in Atlanta, wrote that these findings suggest that wound blush may be a valuable endpoint for predicting a CLI ulcer’s chances of healing.
“This paper provides us a potential beacon to look for in the stormy seas of CLI therapy,” Klein wrote. “An objective scoring and assessment of wound blush during [endovascular therapy] should provide a strong signal that there is a more than reasonable chance that the wound will heal. Though this needs to be confirmed in large studies, this represents one viable option for determining whether there has been sufficient vascularization.” – by Jennifer Byrne
Disclosure: The researchers and Klein report no relevant financial disclosures.