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Predictors of non‐healing in patients with critical limb ischemia and tissue loss following successful endovascular therapy
Author(s) -
Kobayashi Norihiro,
Hirano Keisuke,
Nakano Masatsugu,
Muramatsu Toshiya,
Tsukahara Reiko,
Ito Yoshiaki,
Ishimori Hiroshi,
Yamawaki Masahiro,
Araki Motoharu,
Kato Tamon
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25625
Subject(s) - medicine , critical limb ischemia , hazard ratio , wound healing , revascularization , proportional hazards model , confidence interval , digital subtraction angiography , surgery , hemodialysis , angiography , myocardial infarction
Objectives To evaluate the predictors of non‐healing in patients with critical limb ischemia (CLI) after successful endovascular therapy (EVT). Background Occasionally, wound healing in patients with CLI and tissue loss cannot be achieved even after successful EVT. Patient's co‐morbidities, vascular anatomy, wound features, and interventional strategies/outcomes are associated with the probability of wound healing. Methods Between April 2007 and October 2012, 182 patients with CLI (220 limbs) with tissue loss were treated with EVT in our institute. Of these, 164 individual wounds (130 patients, 149 limbs) out of 243 individual wounds were successfully treated. Successful EVT was defined as revascularization by achieving visible blood flow to the wounds, as evaluated by digital subtraction angiography performed just after EVT. A Cox proportional hazards model was used to analyze predictors associated with wound healing. Results The mean follow‐up period was 23 ± 18 months. The wound healing rates were 40.2%, 57.3%, 62.2%, and 70.7% at 3, 6, 9, and 12 months, respectively. Multivariate Cox proportional hazards analysis revealed that insulin use [hazard ratio (HR), 0.541; 95% confidence interval (CI), 0.329–0.890; P = 0.016], dependence on hemodialysis [HR, 0.429; 95% CI, 0.272–0.678; P < 0.001], and major tissue loss [HR, 0.460; 95% CI, 0.294–0.720; P = 0.001] were independent predictors of non‐healing after successful EVT. Conclusions Insulin use, dependence on hemodialysis, and major tissue loss were independent predictors of non‐healing after successful EVT. © 2014 Wiley Periodicals, Inc.