This article is more than 5 years old. Information may no longer be current.
Predictors of delayed wound healing after endovascular therapy for CLI identified
Click Here to Manage Email Alerts
Wound nonhealing after endovascular therapy for below-the-knee lesions in patients with critical limb ischemia was predicted by various factors concerning the general condition of the patient and the condition of the limb, researchers reported.
Sushant Kumar Das, MD, from the department of interventional and vascular surgery at Shanghai Tenth People’s Hospital, Tongji University, Shanghai, and colleagues conducted a retrospective analysis of wound healing rates for 118 patients who had successful below-the-knee endovascular therapy for CLI with tissue loss between May 2008 and June 2013.
The researchers also calculated independent predictors of delayed wound healing.
Among the cohort, 81 patients (mean age, 70 years; 68% men) had their wounds heal completely at 12 months and 37 patients (mean age, 73 years; 65% men) did not.
Wound healing rates in the overall cohort were 13.9% at 3 months, 43.8% at 6 months, 57.7% at 9 months and 65.7% at 12 months, according to the researchers.
Das and colleagues identified the following parameters as independent predictors of wound nonhealing after successful endovascular therapy for CLI:
- end-stage renal disease requiring dialysis (HR = 2.6; 95% CI, 1-6.3);
- albumin level less than 3 g/dL (HR = 2; 95% CI, 1.1-3-8);
- C-reactive protein level greater than 5 mg/dL (HR = 3.9; 95% CI, 1.6-9.6);
- major tissue loss (HR = 2.1; 95% CI, 1.3-3.4);
- wound infection (HR = 1.9; 95% CI, 1.2-2.9);
- gangrene (HR = 1.8; 95% CI, 1.2-2.8);
- wound depth of University of Texas grade 3 (HR = 3.4; 95% CI, 1.4-8.6);
- duration of ulcer of 2 months or more (HR = 2.9; 95% CI, 1-8.4);
- insulin use (HR = 1.7; 95% CI, 1-2.8); and
- lack of below-the-ankle runoff (HR = 1.9; 95% CI, 1-3.4).
“Risk stratifications according to the identified predictors will allow the future occurrence of each endpoint to be predicted, thus helping to identify patients and lesions that are less suitable for [endovascular therapy] and those likely to derive the most benefit,” Das and colleagues wrote. “The current results suggest that wound depth and duration, which are not currently in routine risk stratification of CLI patients, should be included in the risk stratification process because chronic and deep wounds are more likely to be infected and to yield poorer outcomes.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
Click Here to Manage Email Alerts