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Influence of inframalleolar modifier P0/P1 on wound healing in bypass surgery vs endovascular therapy in patients with chronic limb-threatening ischemia.
Morisaki, Koichi; Matsuda, Daisuke; Guntani, Atsushi; Kinoshita, Go; Yoshino, Shinichiro; Inoue, Kentaro; Honma, Kenichi; Yamaoka, Terutoshi; Mii, Shinsuke; Yoshizumi, Tomoharu.
Afiliación
  • Morisaki K; Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: morisaki.koichi.533@m.kyushu-u.ac.jp.
  • Matsuda D; Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.
  • Guntani A; Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan.
  • Kinoshita G; Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
  • Yoshino S; Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
  • Inoue K; Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
  • Honma K; Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.
  • Yamaoka T; Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.
  • Mii S; Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan.
  • Yoshizumi T; Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Vasc Surg ; 80(3): 792-799.e1, 2024 Sep.
Article en En | MEDLINE | ID: mdl-38649101
ABSTRACT

OBJECTIVE:

This study aimed to compare the influence of inframalleolar (IM) P0/P1 on wound healing in bypass surgery vs endovascular therapy (EVT) in patients with chronic limb-threatening ischemia (CLTI).

METHODS:

We retrospectively analyzed the multicenter data of patients who underwent infra-inguinal revascularization for CLTI between 2015 and 2022. IM P represents target artery crossing into foot, with intact pedal arch (P0) and absent or severely diseased pedal arch (P1). The endpoints were wound healing, limb salvage (LS), and postoperative complications.

RESULTS:

We analyzed 66 and 189 propensity score-matched pairs in the IM P0 and IM P1 cohorts, respectively. In the IM P0 cohort, the 1-year wound healing rates were 94.5% and 85.7% in the bypass surgery and EVT groups, respectively (P = .092), whereas those in the IM P1 cohort were 86.2% and 66.2% in the bypass surgery and EVT groups, respectively (P < .001). In the IM P0 cohort, the 2-year LS rates were 96.7% and 94.1% in the bypass surgery and EVT groups, respectively (P = .625), and those in the IM P1 cohort were 91.8% and 81.5% in the bypass surgery and EVT groups, respectively (P = .004). No significant differences were observed between the bypass surgery and EVT in terms of postoperative complication rates in either the IM P0 or P1 cohorts.

CONCLUSIONS:

Bypass surgery facilitated better wound healing and LS than EVT in patients with IM P1. Conversely, no differences in wound healing or LS were observed between groups in patients with IM P0. Bypass surgery should be considered a better revascularization strategy than EVT in patients with tissue loss and IM P1 disease.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cicatrización de Heridas / Recuperación del Miembro / Enfermedad Arterial Periférica / Procedimientos Endovasculares / Isquemia Crónica que Amenaza las Extremidades Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cicatrización de Heridas / Recuperación del Miembro / Enfermedad Arterial Periférica / Procedimientos Endovasculares / Isquemia Crónica que Amenaza las Extremidades Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos