Author + information
- Tatsuya Nakama1,
- Kazushi Urasawa2,
- Hiroshi Ando3,
- Daisuke Kamoi4,
- Yoshinori Tsubakimoto5 and
- Yoshisato Shibata1
To investigate the clinical outcomes of pedal artery angioplasty (PAA) for patients with critical limbs ischemia (CLI). Pedal artery disease is considered a predictor of delayed wound-healing after endovascular therapy. Adjunctive PAA might improve the speed and extent of wound-healing.
Consecutive 257 CLI patients presenting with de novo infrapopliteal and pedal artery diseases were retrospectively reviewed from a multicenter registry. Patients were divided into two groups, whether PAA was conducted (PAA group, n=140) or not (non-PAA group, n=117). The wound healing rate and time to wound healing were compared between these groups. Delayed wound healing score (DH-score) was calculated using the number of independent predictors of delayed wound healing. Patients were stratified into three groups depending on the DH-score [low-risk (DH-core: 0), moderate-risk (DH-score: 1-2), high-risk (DH-score: 3)]. Estimated efficacy was analyzed for each risk-stratified population.
The wound-healing rate was significantly higher (57.5% vs. 37.3%, P=0.003) and time to wound healing was significantly shorter (211 days vs. 365 days, P=0.008) in the PAA group. In the multivariate analysis, non-ambulatory status, target wound depth (University of Texas grade ≥2), and daily hemodialysis were revealed as predictors of delayed wound healing. In the moderate-risk population, adjunctive PAA significantly improved the wound healing rate (59.3% vs. 33.9%, P=0.001). In the high-risk population, however, PAA did not affect wound healing.
Patients who received PAA showed higher wound-healing rate and earlier time to wound healing, especially in the moderate-risk population. With regards to wound-healing, this aggressive strategy might become a salvaging procedure for CLI patients presenting with pedal artery diseases.