Additional Risk Stratification Using Local and Systemic Factors for Patients with Critical Limb Ischaemia Undergoing Endovascular Therapy in the WIfI Era

Yosuke Hata; Osamu Iida; Shin Okamoto; Takayuki Ishihara; Kiyonori Nanto; Takuya Tsujumura; Mitsuyoshi Takahara; Toshiaki Mano

doi:10.1016/j.ejvs.2019.06.005

Additional Risk Stratification Using Local and Systemic Factors for Patients with Critical Limb Ischaemia Undergoing Endovascular Therapy in the WIfI Era

Eur J Vasc Endovasc Surg. 2019 Oct;58(4):548-555. doi: 10.1016/j.ejvs.2019.06.005. Epub 2019 Aug 10.

Authors

Yosuke Hata¹, Osamu Iida², Shin Okamoto², Takayuki Ishihara², Kiyonori Nanto², Takuya Tsujumura², Mitsuyoshi Takahara³, Toshiaki Mano²

Affiliations

¹ Kansai Rosai Hospital Cardiovascular Centre, Inabaso, Amagasaki, Hyogo, Japan. Electronic address: hata.yosuke@gmail.com.
² Kansai Rosai Hospital Cardiovascular Centre, Inabaso, Amagasaki, Hyogo, Japan.
³ Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.

PMID: 31409542
DOI: 10.1016/j.ejvs.2019.06.005

Abstract

Objectives: While current guidelines describe the importance of assessing limb characteristics for predicting limb prognosis in patients with critical limb ischaemia (CLI), several reports have also suggested that systemic factors are associated with limb prognosis. The aim of this study was to evaluate whether systemic factors have the same impact on wound healing as limb characteristics in CLI patients undergoing endovascular therapy.

Methods: A total of 735 patients who were treated for the first time for CLI with tissue loss between April 2010 and December 2015 were extracted from a prospective registry and data for the Wound, Ischaemia, and foot Infection (WIfI) classification were searched retrospectively. The predictors of wound healing were explored with Cox proportional hazards regression.

Results: The one year wound healing rate was 60.2% in WIfI stage 1-3 patients and 53.6% in WIfI stage 4 (p = .01). In WIfI stage 1-3, no systemic factors were significantly associated with wound healing, whereas, in WIfI stage 4 patients, non-ambulatory status [hazard ratio (HR) 1.98; 95% confidence interval (CI) 1.37-2.84], haemodialysis (HR 1.90; 95% CI 1.33-2.72) and an albumin level under 3.0 g/dL (HR 1.53; 95% CI 1.02-2.31), were identified as independent risk factors for failure to achieve wound healing. If none or one of these risk factors were present, wound healing was comparable with WIfI 4 and WIfI 1-3 patients (67.7% vs. 63.6%, p = .89), whereas in patients with two or more risk factors wound healing was worse in WIfI 4 than in WIfI 1-3 patients (35.7% vs. 49.5%, p = .01).

Conclusion: Non-ambulatory status, haemodialysis, and a low albumin level were additional systemic risk factors for impaired wound healing in patients with WIfI stage 4. The wound healing rate in WIfI stage 4 patients with one or fewer of these risk factors was comparable to that in WIfI stage 1-3.

Keywords: Critical limb ischaemia; Endovascular therapy; Limb prognosis; Risk stratification; WIfI classification; Wound healing.

MeSH terms

Aged
Aged, 80 and over
Amputation, Surgical
Critical Illness
Endovascular Procedures* / adverse effects
Female
Foot Ulcer / diagnosis
Foot Ulcer / microbiology
Foot Ulcer / therapy*
Humans
Hypoalbuminemia / complications
Ischemia / complications
Ischemia / diagnosis
Ischemia / therapy*
Limb Salvage
Male
Mobility Limitation
Peripheral Arterial Disease / complications
Peripheral Arterial Disease / diagnosis
Peripheral Arterial Disease / therapy*
Registries
Renal Dialysis / adverse effects
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Wound Healing*
Wound Infection / diagnosis
Wound Infection / microbiology
Wound Infection / therapy*