Changes in Skin Perfusion Pressure After Endovascular Treatment for Chronic Limb-Threatening Ischemia

Abstract

Purpose To assess skin perfusion pressure (SPP) changes after endovascular treatment (EVT) of patients with chronic limb-threatening ischemia (CLTI) and to explore preoperative factors that affect SPP changes. Materials and Methods This prospective, multicenter study recruited 147 patients (mean age 74 years; 99 men) with ischemic wounds at 6 vascular centers in Japan between July 2017 and December 2018. Over half of the patients (92, 63%) were diabetic, and 76 (52%) required dialysis. Sixty-four patients (43%) had WIfI (wound, ischemia, foot infection) wound grades of 2 or 3; 59 (40%) had foot infections. SPP was measured before and 1, 2, 7, and 30 days after EVT to establish inline flow to the ischemic foot based on the angiosome concept when feasible. The anterior and posterior tibial arteries and the peroneal artery were revascularized in 66 (45%), 50 (34%), and 30 (21%) patients, respectively. Results Both the dorsal and plantar SPPs at 1 or 2 days post-EVT were significantly higher than those at baseline (p<0.001), and both SPPs increased further at 1 month compared with those at 1 (p=0.001) or 2 days (p=0.006) post-EVT. SPP increases occurred on the dorsal and plantar surfaces of the foot regardless of the vessel revascularized. The SPP increase at 1 month after EVT was significantly lower in patients with foot infections than that in those without foot infections (p=0.003). Age, sex, diabetes, dialysis, wound severity, and direct revascularization did not affect the pattern of SPP change. Conclusion The SPP increased continuously up to 1 month after EVT, though the increase was smaller in patients with wound infections. The SPP on the dorsal and plantar surfaces increased, regardless of the vessel revascularized, which could justify indirect revascularization when direct revascularization is technically challenging.

Angiosome-Guided Endovascular Revascularization for Treatment of Diabetic Foot Ulcers with Peripheral Artery Disease

“…23 IR could also increase the skin perfusion pressure on both the dorsal and plantar surfaces. 24 Although the blood flow provided by IR may be insufficient to heal the ulcer, it can maintain tissue vitality to a certain extent and avoid major amputation. 7,25 In addition, patients in the IR group had a higher mortality rate, and some patients may have died before amputation, resulting in an underestimation of the amputation rate.…”

A Systematic Review and Critical Appraisal of Peri-Procedural Tissue Perfusion Techniques and their Clinical Value in Patients with Peripheral Arterial Disease

“…All six SPP studies, including 315 patients, had a cohort ranging from 16 to 147 patients with Fontaine IIb e IV PAD, showed a significantly improved SPP on the dorsal or plantar side of the foot after intervention. 9,10,23e25, 27 Ikeoka et al also showed a significant improvement in ABPI and ankle pressure. 25 The studies by Mochizuki et al and Kawarada et al were the only ones with clinical follow up, describing clinical outcomes as major amputation rate and wound healing, demonstrating no differences in SPP values between healed and nonhealed limbs.…”

Longitudinal changes in skin perfusion pressure after endovascular therapy in patients with chronic limb-threatening ischemia

“…Recently, Ichihashi et al reported changes in the SPP after endovascular treatment (EVT) and showed that the SPP after EVT increases for up to 1 month, although the data after 1 month are lacking. 9 In addition, no study has assessed foot ischemic changes using the SPP after EVT.…”