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Insulin use, dialysis predicted poor wound healing after endovascular therapy
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Patients undergoing endovascular therapy for critical limb ischemia were significantly more likely to have non-healing wounds if they used insulin, were dependent on hemodialysis or had major tissue loss, according to recent findings.
The researchers aimed to determine factors associated with non-healing of wounds in patients who have undergone successful endovascular therapy for critical limb ischemia (CLI). They suggested that comorbidities particular to the patient, vascular anatomy, wound features and interventional strategies may predict the probability of wound healing.
The analysis included 220 limbs from 182 patients with CLI and tissue loss. Eligible participants were treated with endovascular therapy at a single institute between April 2007 and October 2012.
A successful procedure was defined as one that achieved visible blood flow to the wounds as evaluated by digital subtraction angiography.
The researchers successfully treated 164 (out of 243) individual wounds from 130 patients and 149 limbs.
During a mean follow-up of 23 ± 18 months, the following wound healing rates were reported:
- 40.2% at 3 months;
- 57.3% at 6 months;
- 62.2% at 9 months;
- 70.7% at 12 months.
Insulin use (HR=0.541; 95% CI, 0.329-0.890), dependence on hemodialysis (HR=0.429; 95% CI, 0.272-0.678) and major tissue loss (HR=0.460; 95% CI, 0.294-0.720) independently predicted non-healing after a successful procedure, according multivariate analysis results.
The researchers added that among high-risk CLI patients, in whom the wound healing and freedom from repeat target limb revascularization rates were low, surgery may be appropriate if they have adequate inflow and outflow vessels, adequate venous conduit and acceptable surgical risk.
“However, this ideal candidate is not represented amongst CLI patients, leaving [endovascular therapy] as the modality of choice for most of the ‘real world’ subset of complex CLI patients,” they wrote. “The outcomes of [endovascular therapy] in this group of patients are bound to improve with the evolution of currently utilized technologies, including drug-coated balloons and [drug-]eluting stents, as well as different atherectomy modalities and even cell therapies.”
Disclosure: The researchers report no relevant financial disclosures.
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