Predictors of adverse clinical outcomes after successful infrapopliteal intervention

Kawarada, Osami; Fujihara, Masahiko; Higashimori, Akira; Yokoi, Yoshiaki; Honda, Yasuhiro; Fitzgerald, Peter J.

doi:10.1002/ccd.24370

Cited by 153 publications

(133 citation statements)

References 37 publications

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“…Although there are few published studies investigating predictors of not only limb salvage or death, but also of "wound healing," Iida et al 28 reported that a body mass index (BMI) of <18.5 (HR, 0.54; P=0.03) and wound infection (HR, 0.60; P=0.04) were predictors of unhealed wounds. Furthermore, Kawarada et al 18 reported that DM, infectious wounds, and pedal arch fection and gangrene rates were higher in group E than in the other 2 groups (group T and H; infection; group T 34%, group H 48%, and group E 83%, P<0.001; gangrene: group T 40%, group H 68%, and group E 83%, P=0.001). Both ABI and SPP improved and were similar in all 3 groups after EVT (ABI: group T 0.89±0.16, group H 0.81±0.13, and group E 0.87±0.12; P=0.45; SPP: group T 53±23 mmHg, group H 52±22 mmHg, and group E 53±19 mmHg; P=0.15).…”

Section: Discussionmentioning

confidence: 96%

Wound Healing and Wound Location in Critical Limb Ischemia Following Endovascular Treatment

Kobayashi

Hirano

Nakano

et al. 2014

Circ J

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Section: Discussionmentioning

confidence: 96%

Wound Healing and Wound Location in Critical Limb Ischemia Following Endovascular Treatment

Kobayashi

Hirano

Nakano

et al. 2014

Circ J

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“…Also, a relatively low-dose (3,500-5,000 IU) of heparin appears to be acceptable for Japanese patients undergoing current lower limb interventions. 12, 15 However, there is no consensus regarding the established protocol of antiplatelet therapy and heparinization. Stenotic lesions can be crossed in the same fashion as in a coronary intervention.…”

Section: Endovascular Crossing Technique and Management Of Complicationsmentioning

confidence: 99%

“…With the development of guidewire technology and proliferative endovascular chronic total occlusion (CTO) crossing techniques, current procedural success rates could be approximately 90%. 14, 15 Given that the severity of pedal arch is significantly associated with wound healing, 15,34,35 belowthe-ankle intervention based on an assessment of the microcirculation such as SPP or TCPO2 is a key component of treating challenging cases, together with liberal debridement 12,18,32 ( Figure 2C). If technically feasible, complete revascularization (3-vessel revascularization) may enhance wound healing.…”

Section: Endovascular Crossing Technique and Management Of Complicationsmentioning

confidence: 99%

“…Moreover, the freedom from reintervention rate was 55.0%, 49.6%, 44.4%, and 36.1% ( Figure 5A). 15 These finding suggest a substantial discrepancy between freedom from reintervention and avoidance of limb loss, and that the sustained limb salvage rate is related to poor survival and the effects of the competing mortality hazard.…”

Section: Application Of Practical Endpoints and Clinical Outcomesmentioning

confidence: 99%

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Contemporary Infrapopliteal Intervention for Limb Salvage and Wound Healing

Kawarada

Yasuda

Huang

et al. 2014

Circ J

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“…Kawarada et al also reported that their pedal arch classification had a great effect on ulcer healing after EVT, and that ulcer healing times were similar between DR and IR. 10 There are also reports stating that IR should be differentiated as IR without collateral and IR with collateral (IRc). 56, 57 However, difficult problems remain regarding how to evaluate the reliability of collateral blood flow on ulcer healing if a stenotic lesion is present in the collateral vessels or the inflow artery of the collateral circulation.…”

Section: Impact Of Pedal Arch Quality and The Arterial-arterial Connementioning

confidence: 99%

Ulcer Healing After Peripheral Intervention

Azuma

Koya

Uchida

et al. 2014

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp panied by an increase in renal diseases, and the incidence of peripheral arterial disease (PAD) among dialysis patients is also increasing. In Japan, 50% of CLI patients have endstage renal disease (ESRD). 7 Furthermore, populations are aging rapidly in advanced countries; in other words, disease duration is increasing among DM and ESRD patients, in turn, increasing the risk of triggering and advancing arterial diseases. In this patient group, vascular disease is also accompanied by microangiopathy, which causes CLI with tissue loss.Analysis of the factors that impair the ulcer healing process in highly heterogeneous CLI patient groups is complicated. To establish a revascularization strategy after properly determining the healing vs. impairing factors, it is essential to gather ample data on post-revascularization ulcer healing. However, such reports are few, and even the guidelines do not provide revascularization procedural options from the viewpoint of ulcer healing.This review organized the reported factors that impair ulcer healing and identified those that clearly have a major effect on revascularization outcome and limb prognosis. We highlight the factors that are useful in planning revascularization strategies from the viewpoint of ulcer healing. dvancements in endovascular treatment (EVT) for critical limb ischemia (CLI) have enabled vascular surgeons, cardiologists and radiologists to participate in revascularization procedures. However, the number of experts in post-revascularization ulcer management has not caught up with the increasing number of revascularization procedures. Moreover, both education and knowledge regarding ulcer healing are insufficient for physicians performing revascularization. The treatment guideline for diabetic foot ulcers is well-established, 1 but evidence supporting strategies for the complete healing of ischemic ulcers after revascularization remains scant.Among the many studies that have reported limb salvage, complete ulcer healing was reported in only 17 studies (0.9%) according to a literature search from 1985 to 2005. 2 However, ulcer healing after revascularization is a major concern among patients, and the expected healing period is important in terms of health economics and the patient's quality of life (QOL). 3,4 Furthermore, information clarifying stubborn ulcers is meaningful for preventing the onset of ulcers and to educate the medical personnel who may potentially make an early discovery of such ulcers.In particular, there has been a tremendous worldwide increase in the number of patients with diabetes mellitus (DM) and the percentage of CLI patients with DM is increasing markedly, currently accounting for 70%. 5, 6 The increase in DM is accom- Complete ulcer healing is one of the most important goals of treatment for critical limb ischemia; however, it is still difficult to inform patients of the time to ulcer healing before performing revascularization. The tim...

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Predictors of adverse clinical outcomes after successful infrapopliteal intervention

Abstract: An infectious wound, comorbidities of diabetes mellitus and ESRD on hemodialysis and classification of pedal arch can be predictors of adverse clinical outcomes after successful infrapopliteal intervention.

Cited by 153 publications

References 37 publications

Wound Healing and Wound Location in Critical Limb Ischemia Following Endovascular Treatment

Wound Healing and Wound Location in Critical Limb Ischemia Following Endovascular Treatment

Contemporary Infrapopliteal Intervention for Limb Salvage and Wound Healing

Ulcer Healing After Peripheral Intervention

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