Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
J Endovasc Ther. 2023 Oct;30(5):703-710. doi: 10.1177/15266028221098702. Epub 2022 Jun 16.
Chronic limb-threatening ischemia due to isolated below-the-knee lesions is a factor associated with wound recurrence. However, there is a lack of data regarding wound recurrence in such cases. This study aimed to determine the predictors of wound recurrence in patients with chronic limb-threatening ischemia undergoing endovascular treatment.
This was a single-center, retrospective, observational study. We enrolled 152 consecutive patients with chronic limb-threatening ischemia (172 limbs) who achieved complete wound healing after undergoing endovascular treatment for isolated below-the-knee lesions between February 2008 and December 2017. Of these, the wound had recurred in 56 limbs (33%), and we divided the patients into 2 groups based on wound recurrence. We evaluated the recurrence rate of chronic limb-threatening ischemia and predictors of wound recurrence. Wound recurrence was defined as recurrence of the wound within 2 years of complete wound healing.
Patients' backgrounds were similar in both groups, including mean age (72±9 vs 72±11; p=0.76) and hemodialysis (43% vs 40%; p=0.66). Pre-pedal arch type 2 (52% vs 8%; p<0.01), infrapopliteal grade 4 of the Global Limb Anatomic Staging System (77% vs 59%; p=0.02), and Wound, Ischemia, and foot Infection criteria stage 4 (43% vs 28%; p=0.04) were more common in the wound recurrence group. Multivariate Cox proportional hazard analysis identified pre-pedal arch type 2 (hazard ratio, 5.28; 95% confidence interval, 3.08-9.10; p<0.01) and Wound, Ischemia, and foot Infection criteria stage 4 (hazard ratio, 1.98; 95% confidence interval, 1.15-3.36; p=0.01) as predictors of wound recurrence after complete wound healing.
Pre-pedal arch type 2 and Wound, Ischemia, and foot Infection classification system stage 4 were associated with wound recurrence in patients with chronic limb-threatening ischemia who achieved complete wound healing after undergoing endovascular treatment for isolated below-the-knee lesions.
由孤立性膝下病变引起的慢性肢体威胁性缺血是导致创面复发的因素。然而，关于此类病例创面复发的数据尚缺乏。本研究旨在确定接受腔内治疗的慢性肢体威胁性缺血患者创面复发的预测因素。
这是一项单中心、回顾性、观察性研究。我们纳入了 2008 年 2 月至 2017 年 12 月期间因孤立性膝下病变接受腔内治疗后创面完全愈合的 152 例慢性肢体威胁性缺血患者（172 条肢体）。其中 56 条肢体（33%）出现创面复发，我们根据创面复发情况将患者分为 2 组。评估慢性肢体威胁性缺血的复发率和创面复发的预测因素。创面复发定义为创面完全愈合后 2 年内复发。
两组患者的背景相似，包括平均年龄（72±9 岁比 72±11 岁；p=0.76）和血液透析（43%比 40%；p=0.66）。在预踝弓 2 型（52%比 8%；p<0.01）、下肢分级系统 4 级（77%比 59%；p=0.02）和创面、缺血和足部感染分级系统 4 期（43%比 28%；p=0.04）的患者更为常见。多变量 Cox 比例风险分析确定预踝弓 2 型（危险比，5.28；95%置信区间，3.08-9.10；p<0.01）和创面、缺血和足部感染分级系统 4 期（危险比，1.98；95%置信区间，1.15-3.36；p=0.01）是完全愈合后创面复发的预测因素。
预踝弓 2 型和创面、缺血和足部感染分级系统 4 期与接受腔内治疗的孤立性膝下病变患者完全愈合后创面复发相关。
