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Wound Healing: An endpoint for complex peripheral angioplasty
Insights
Minimally invasive endovascular procedures combined with wound care effectively heal chronic leg ulcers in high-risk patients. This approach offers a viable alternative to amputation for end-stage ischemia.
Area of Science:
- Vascular Surgery
- Wound Healing
- Endovascular Interventions
Background:
- Long-term patency is the standard for lower limb revascularization.
- Chronic ulcer healing is an acceptable endpoint for high-risk patients with end-stage ischemia.
Purpose of the Study:
- To evaluate the efficacy of minimally invasive endovascular interventions combined with comprehensive wound healing procedures for resolving nonhealing chronic lower extremity ulcerations.
- To assess wound healing rates in high-risk patients with end-stage ischemia.
Main Methods:
- Retrospective review of 85 patients (96 limbs) treated at San Francisco Wound Care Center.
- Procedures included Palmaz stents (iliac occlusions), balloon angioplasty (superficial femoral/popliteal lesions), and rotational atherectomy (tibioperoneal lesions).
- Comprehensive wound management, including growth factors, was utilized.
Main Results:
- Group I (stents): All wounds healed; 6/7 required outflow procedures.
- Groups II (angioplasty) & III (atherectomy): Primary patencies were 64% & 70%; secondary patencies were 71% & 78%.
- Wound healing at 5 months: 90% in Group II, 72% in Group III. Amputations: 1 in Group II, 5 in Group III.
Conclusions:
- Endovascular procedures play a significant role in healing chronic lower extremity ulcerations in high-risk patients.
- This approach offers a promising alternative for limb salvage in end-stage ischemic disease.
Purpose:
The standard endpoint for lower limb revascularization is long-term patency; however, in high-risk patients with end-stage ischemia, healing of chronic ulcerations has been proposed as an acceptable endpoint. To evaluate if today's minimally invasive interventions, in combination with comprehensive wound healing procedures, can resolve nonhealing wounds, we performed a retrospective review of chronic ulceration patients treated at the San Francisco Wound Care Center.
Methods:
Eight-five patients with 96 limbs at risk due to nonhealing ulcers were treated with a variety of endovascular procedures: 7 patients (group I) received Palmaz stents for unilateral iliac occlusions; 42 limbs (group II) in 39 patients were treated with balloon angioplasty for superficial femoral and popliteal lesions; and 47 extremities in 39 patients (group III) underwent rotational atherectomy for tibioperoneal lesions. Comprehensive wound management techniques, including the application of growth factors, were used.
Results:
All group I wounds healed, although 6 of 7 patients required additional procedures to address outflow lesions. In groups II and III, primary patencies were similar (64% and 70%, respectively), and nine treated sites reoccluded in each group. Restenotic lesions were retreated in both groups (three in group II and four in group III) secondary patencies were 71% and 78%, respectively. There were more amputations in group III patients (five) compared to group II (one). In both groups after 5 months, 90% of wounds had healed in group II and 72% in group III.
Conclusion:
The use of endovascular procedures appears to play an important role in the healing of chronic lower extremity ulcerations in high-risk patients with end-stage ischemia.
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