Clinical Outcomes of Pedal Artery Angioplasty for Patients With Ischemic Wounds: Results From the Multicenter RENDEZVOUS Registry

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• 作者：Tatsuya Nakama ; MD^a ; ^{tatsuya_nakama@med.miyazaki-u.ac.jp} ; Nozomi Watanabe ; MD^a ; Takuya Haraguchi ; MD^b ; Hiroshi Sakamoto ; MD^c ; Daisuke Kamoi ; MD^d ; Yoshinori Tsubakimoto ; MD^e ; Kenji Ogata ; MD^a ; Katsuhiko Satoh ; MD^b ; Kazushi Urasawa ; MD^b ; Hiroshi Andoh ; MD^c ; Hiroshi Fujita ; MD^e ; Yoshisato Shibata ; MD^a
• 关键词：below-the-ankle intervention ; critical limb ischemia ; endovascular therapy ; pedal artery diseases ; peripheral arterial diseases ; wound healing
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2017
• 出版时间：9 January 2017
• 年：2017
• 卷：10
• 期：1
• 页码：79-90
• 全文大小：1975 K
• 卷排序：10

文摘

The aim of this study was to investigate the clinical outcomes of pedal artery angioplasty (PAA) for patients with critical limb ischemia.BackgroundPedal artery disease is considered a predictor of delayed wound healing (DH) after endovascular therapy. Adjunctive PAA might improve the speed and extent of wound healing.MethodsConsecutive patients with critical limb ischemia (n = 257) presenting with de novo infrapopliteal and pedal artery disease were retrospectively reviewed from a multicenter registry. Patients were divided into 2 groups according to whether PAA was performed (n = 140) or not (n = 117). The rate of wound healing and time to wound healing were compared between these groups. DH score was calculated using the number of independent predictors of DH. Patients were stratified into 3 groups according to DH score: low risk (DH score = 0), moderate risk (DH score = 1 or 2), and high risk (DH score = 3). Estimated efficacy was analyzed for each risk-stratified population.ResultsThe rate of wound healing was significantly higher (57.5% vs. 37.3%, p = 0.003) and time to wound healing significantly shorter (211 days vs. 365 days; p = 0.008) in the PAA group. In a multivariate analysis, nonambulatory status, target wound depth (UT grade ≥2), and daily hemodialysis were revealed as predictors of DH. In the moderate-risk population, adjunctive PAA significantly improved the rate of wound healing (59.3% vs. 33.9%; p = 0.001). In the high-risk population, however, PAA did not affect wound healing.ConclusionsPatients who underwent PAA showed a higher rate of wound healing and shorter time to wound healing, especially in the moderate-risk population. With regard to wound healing, this aggressive strategy might become a salvage procedure for patients with critical limb ischemia presenting with pedal artery disease.