Wound Healing: An endpoint for complex peripheral angioplasty

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.