Shahat Mohammed, Taha Ashraf G, Elnaggar Ashraf, Aboloyoun Hesham
Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt.
Vascular. 2024 Sep 10:17085381241283096. doi: 10.1177/17085381241283096.
Predicting the outcomes of endovascular revascularization of chronic limb-threatening ischemia (CLTI) patients with foot wounds can be challenging. Angiographic wound blush (WB) assessment has been found to be a helpful tool to assess wound perfusion. The aim of this study is to evaluate WB during endovascular revascularization of CLTI patients and its effects on treatment outcomes.
This prospective study included all CLTI patients with foot wounds who underwent successful endovascular revascularization of infrainguinal arterial disease between 2019 and 2021. Patients were grouped according to the WB status into positive WB (group A) and negative WB (group B). Both groups were compared for demographics, comorbidities, clinical picture, and 12-month limb-based patency (LBP) and amputation-free survival (AFS) rates.
The study included 69 patients of Rutherford classes 5 (46.4%) and 6 (53.6%), with the main arterial lesion located at the femoropopliteal (58%) or infrapopliteal (42%) segments. Completion angiography showed positive WB in 38 (55.1%) patients and negative WB in 31 (44.9%) patients. Both groups were comparable regarding patient presentation, site of the main arterial lesion, and distribution of foot lesions in relation to the feeding artery. The overall 12-month LBP and AFS rates were 21.7% and 39.1%, respectively, with significantly better rates in group A than in group B (LBP, 31.6% vs 9.7%, = 0.001 and AFS, 54.1% vs 22.2%, = 0.006, respectively). Successful angiosome-based direct flow to the foot was achieved in 38 patients (55.1%), resulting in significantly better 12-month AFS rates than those with indirect revascularization (54.8% vs 26.3%, = 0.036, respectively), despite the comparable 12-LBP rates between the direct and indirect revascularization groups (29% vs 15.8%, = 0.133, respectively). Multivariate logistic regression analysis identified smoking as a significant predictor of a major amputation, whereas positive WB and successful direct revascularization were significant predictors of limb salvage.
WB can serve as a predictor for AFS and LBP during endovascular revascularization of CLTI patients with foot wounds. A positive WB may guide the decision to conclude an endovascular procedure, potentially avoiding unnecessary complicated maneuvers to recanalize more vessels. Conversely, a negative WB may suggest the need for further revascularization attempts to augment wound perfusion and healing.
预测患有足部伤口的慢性肢体威胁性缺血（CLTI）患者血管内血运重建的结果可能具有挑战性。血管造影伤口充血（WB）评估已被发现是评估伤口灌注的有用工具。本研究的目的是评估CLTI患者血管内血运重建期间的WB及其对治疗结果的影响。
这项前瞻性研究纳入了2019年至2021年间所有接受成功的股腘以下动脉疾病血管内血运重建的患有足部伤口的CLTI患者。患者根据WB状态分为阳性WB组（A组）和阴性WB组（B组）。比较两组患者的人口统计学、合并症、临床表现以及12个月的肢体通畅率（LBP）和无截肢生存率（AFS）。
该研究纳入了69例卢瑟福分级为5级（46.4%）和6级（53.6%）的患者，主要动脉病变位于股腘段（58%）或腘下段（42%）。血管造影完成时，38例（55.1%）患者显示阳性WB，31例（44.9%）患者显示阴性WB。两组在患者表现、主要动脉病变部位以及足部病变相对于供血动脉的分布方面具有可比性。总体12个月的LBP和AFS率分别为21.7%和39.1%，A组的比率显著高于B组（LBP，31.6%对9.7%，P = 0.001；AFS，54.1%对22.2%，P = 0.006）。38例患者（55.1%）成功实现了基于血管体的足部直接血流，其12个月的AFS率显著高于间接血运重建患者（分别为54.8%对26.3%，P = 0.036），尽管直接和间接血运重建组之间的12个月LBP率相当（分别为29%对15.8%，P = 0.133）。多因素逻辑回归分析确定吸烟是大截肢的重要预测因素，而阳性WB和成功的直接血运重建是肢体挽救的重要预测因素。
WB可作为患有足部伤口的CLTI患者血管内血运重建期间AFS和LBP的预测指标。阳性WB可能指导决定结束血管内手术，潜在地避免为再通更多血管而进行不必要的复杂操作。相反，阴性WB可能提示需要进一步进行血运重建尝试以增强伤口灌注和愈合。
