Heel Wounds Predict Mortality but Not Amputation after Infrapopliteal Revascularization

Area of Science:

• Vascular Surgery
• Podiatry
• Diabetic Foot Care

Background:

• Ischemic heel ulcerations often have a poor prognosis for limb salvage.
• Infrapopliteal revascularization aims to improve outcomes for critical limb ischemia.
• This study investigates outcomes for heel wounds compared to forefoot wounds after revascularization.

Purpose of the Study:

• To compare wound healing rates and amputation-free survival (AFS) in patients with ischemic heel wounds versus forefoot wounds undergoing infrapopliteal revascularization.
• To identify predictors of mortality in patients with ischemic foot wounds.

Main Methods:

• Retrospective review of patients with ischemic foot wounds and infrapopliteal arterial disease (2006-2013).
• Patients underwent pedal bypass or endovascular tibial artery intervention.
• Outcomes analyzed by initial wound classification, focusing on major amputation or death.

Main Results:

• Heel wounds (12.1%) were associated with higher rates of diabetes mellitus and renal insufficiency.
• Wound healing and major amputation rates at 1 year were similar for heel and forefoot wounds.
• One- and 3-year amputation-free survival (AFS) was significantly lower for heel wounds (45.7%/17.6%) compared to forefoot wounds (66.2%/44.0%).
• Multivariate analysis identified heel wounds as a predictor of death, with endovascular intervention showing a protective effect in heel wound patients.

Conclusions:

• Patients with heel ulcerations undergoing infrapopliteal revascularization experience higher mortality despite comparable amputation and healing rates.
• An endovascular-first strategy may benefit patients with heel ulcerations.
• Wound location is a critical factor in predicting outcomes after revascularization for critical limb ischemia.