Prognosis of critical limb ischemia patients with tissue loss after achievement of complete wound healing by endovascular therapy

• Published in: Journal of vascular surgery Vol. 61; no. 4; pp. 951 - 959
• Main Authors: Kobayashi, Norihiro, MD, Hirano, Keisuke, MD, Nakano, Masatsugu, MD, PhD, Ito, Yoshiaki, MD, Ishimori, Hiroshi, MD, PhD, Yamawaki, Masahiro, MD, PhD, Tsukahara, Reiko, MD, PhD, Muramatsu, Toshiya, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Age Factors; Aged; Aged, 80 and over; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Angioplasty, Balloon - mortality; Critical Illness; Female; Humans; Ischemia - diagnosis; Ischemia - mortality; Ischemia - physiopathology; Ischemia - therapy; Japan; Kaplan-Meier Estimate; Limb Salvage; Lower Extremity - blood supply; Male; Middle Aged; Mobility Limitation; Multivariate Analysis; Proportional Hazards Models; Recurrence; Retrospective Studies; Risk Factors; Stents; Surgery; Time Factors; Treatment Outcome; Wound Healing; Japan
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2014.11.065

Objective Critical limb ischemia (CLI) patients with tissue loss have been recognized to have a poor survival rate. In this study, we aimed to determine whether the prognosis of CLI patients with tissue loss improves after complete wound healing is achieved by endovascular therapy. Methods We treated 187 CLI patients with tissue loss by endovascular therapy from April 2007 to December 2012. Among these patients, 113 patients who achieved complete wound healing were enrolled. The primary end point was survival rate at 3 years. The secondary end points were limb salvage rate and recurrence rate of CLI at 3 years. Results The mean follow-up period after achievement of complete wound healing was 32 ± 18 months. At 1 year, 2 years, and 3 years, the survival rates were 86%, 79%, and 74%; the limb salvage rates were 100%, 100%, and 100%; the recurrence rates of CLI were 2%, 6%, and 9%, respectively. On multivariate Cox proportional hazard analysis, age >75 years (hazard ratio, 3.18; 95% confidence interval, 1.23-8.24; P  = .017) and nonambulatory status (hazard ratio, 2.46; 95% confidence interval, 1.08-5.65; P  = .035) were identified as independent predictors of death for CLI patients with tissue loss even after complete wound healing was achieved. The Kaplan-Meier curve for the overall survival rate at 3 years showed that CLI patients of older age (>75 years) had a significantly decreased survival rate compared with CLI patients of younger age (≤75 years) (58% vs 87%; log-rank test, P  < .001). In addition, nonambulatory CLI patients had a significantly poor survival rate relative to ambulatory CLI patients (40% vs 93%; log-rank test, P  < .001). Conclusions The overall survival rate of CLI patients was acceptable and the recurrence rate of CLI was extremely low once complete wound healing was achieved. Nonambulatory status and age >75 years can serve as predictors of death even after complete wound healing is achieved.