Predictors of delayed wound healing after successful isolated below-the-knee endovascular intervention in patients with ischemic foot ulcers

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Objective:The purpose of this study was to explore the predictors of delayed wound healing and their use in risk stratification for endovascular treatment (EVT) of patients with critical limb ischemia (CLI) due to isolated below-the-knee lesions.Methods:Wound healing rates were analyzed retrospectively in patients who underwent successful below-the-knee percutaneous transluminal balloon angioplasty for CLI with tissue loss between May 2008 and June 2013. We also analyzed the independent predictors of delayed wound healing and their use in risk stratification.Results:The cumulative wound healing rates were 13.9%, 43.8%, 57.7%, and 65.7% at 3, 6, 9, and 12 months, respectively. Multivariate Cox proportional hazards analysis revealed the following as independent predictors of wound nonhealing after initial successful EVT: patients with end-stage renal disease receiving dialysis (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.0–6.3; P = .04); albumin level <3.0 g/dL (HR, 2.0; 95% CI, 1.1–3.8; P = .02); C-reactive protein level >5.0 mg/dL (HR, 3.9; 95% CI, 1.6–9.6; P = .003); major tissue loss (HR, 2.1; 95% CI, 1.3–3.4; P = .003); wound infection (HR, 1.9; 95% CI, 1.2–2.9; P = .005); gangrene (HR, 1.8; 95% CI, 1.2–2.8; P = .008); wound depth (University of Texas grade 3; HR, 3.4; 95% CI, 1.4–8.6; P = .009); duration of ulcer (≥2 months; HR, 2.9; 95% CI, 1.0–8.4; P = .048); insulin use (HR, 1.7; 95% CI, 1.0–2.8; P = .04); and lack of below-the-ankle runoff (HR, 1.9; 95% CI, 1.0–3.4; P = .04).Conclusions:The general status of the patient and the target limb's condition are important predictors of wound nonhealing. Regarding the limb's condition, information on wound depth and duration in addition to wound extent and infection would further enable the selection of suitable CLI patients for EVT. Such information would also enable optimal wound management, leading to successful wound healing and improved limb salvage and survival rates.

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