Prognostic factors of ulcer healing and amputation-free survival in patients with critical limb ischemia

• Published in: Vascular 2018-12, Vol.26 (6), p.626-633
• Main Authors: Furuyama, Tadashi, Onohara, Toshihiro, Yamashita, Sho, Yoshiga, Ryosuke, Yoshiya, Keiji, Inoue, Kentaro, Morisaki, Koichi, Kyuragi, Ryoichi, Matsumoto, Takuya, Maehara, Yoshihiko
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Amputation; Critical Illness; Debridement; Disease-Free Survival; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Humans; Ischemia - diagnosis; Ischemia - mortality; Ischemia - therapy; Japan; Leg Ulcer - diagnosis; Leg Ulcer - mortality; Leg Ulcer - therapy; Limb Salvage; Lower Extremity - blood supply; Male; Middle Aged; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - mortality; Peripheral Arterial Disease - therapy; Phosphodiesterase 3 Inhibitors - adverse effects; Phosphodiesterase 3 Inhibitors - therapeutic use; Retrospective Studies; Risk Factors; Tetrazoles - adverse effects; Tetrazoles - therapeutic use; Time Factors; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; Wound Healing
• ISSN: 1708-5381; 1708-539X
• DOI: 10.1177/1708538118786864

Objective A multidisciplinary approach is required to treat critical limb ischemia. We determined the poor prognostic factors of ischemic ulcer healing after optimal arterial revascularization, and assessed the efficacy of the medication therapy using cilostazol, which is a selective inhibitor of phosphodiesterase 3. Methods In this retrospective, single-center, cohort study, 129 limbs that underwent infrainguinal arterial revascularization for Rutherford class 5 critical limb ischemia were reviewed. The primary end point was the ulcer healing time after arterial revascularization. The secondary end point was the amputation-free survival rate. Results Of the 129 limbs, endovascular therapy was performed in 69 limbs, and surgical reconstructive procedures were performed in 60 limbs for initial therapy. Complete ulcer healing was achieved in 95 limbs (74%). The median ulcer healing time was 90 days. In multivariate analysis, no cilostazol use significantly inhibited ulcer healing (p = 0.0114). A white blood cell count >10,000 (p = 0.0185), a major defect after debridement (p = 0.0215), and endovascular therapy (p = 0.0308) were significant poor prognostic factors for ulcer healing. Additionally, ischemic heart disease (p