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Outcomes of Pedal Artery Angioplasty for Ischemic Wounds
Study Questions:
What are the clinical outcomes of pedal artery angioplasty (PAA) for patients with critical limb ischemia (CLI)?
Methods:
The authors reported the outcome of 257 CLI patients presenting with de novo infrapopliteal and pedal artery diseases whose outcome was tracked in a multicenter registry. Patients were divided into two groups, whether PAA was conducted (PAA group, n = 140) or not (non-PAA group, n = 117), and the wound-healing rate and time to wound-healing were compared between these groups.
Results:
PAA was associated with a higher rate of, (57.5% vs. 37.3%, p = 0.003) and shorter time to, wound-healing (211 days vs. 365 days, p = 0.008). Independent predictors of delayed wound-healing were nonambulatory status, target wound depth (University of Texas grade ≥2), and daily hemodialysis. PAA was associated with improved healing in the moderate-risk population (59.3% vs. 33.9%, p = 0.001), but there was no impact of wound-healing in the high-risk population.
Conclusions:
PAA was associated with a higher wound-healing rate and earlier time to wound-healing, especially in the moderate-risk population.
Perspective:
Aggressive revascularization appears to be associated with dramatic improvement in limb salvage in patients with CLI. Pedal artery intervention is an uncommon procedure and is currently being performed by a small number of operators. The results of this study add to the evidence supporting the use of PAA for improving wound healing in appropriately selected patients. Future studies are needed to define the best technical approach for PAA and to prospectively identify patients most likely to benefit from this approach.
Keywords: Angiography, Heart Valve Diseases, Angioplasty, Ischemia, Limb Salvage, Renal Dialysis, Wound Healing, Vascular Diseases
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