Clinical Effects of Planned Endovascular Therapy for Critical Limb Ischemia Patients with Tissue Loss

Aim: The aim of this study was to investigate the clinical effect of planned endovascular therapy (EVT) for critical limb ischemia (CLI) patients with tissue loss. Although several rounds of EVT for CLI patients are required for complete wound healing, time required for complete wound healing depends on the wound severity. We hypothesized that planned EVT might reduce the time to wound healing. Methods: A total of 89 limbs of 76 CLI patients with tissue loss, who had undergone more than at least two EVTs were included in this study. From January 2013 through December 2015 (Conventional-EVT-group, 52 limbs), indication of target lesion revascularization (TLR) was decided based on decreased skin perfusion pressure (SPP) values or delayed wound healing. From January 2016 through October 2016 (Planned-EVT-group, 37 limbs), TLR were done every two months regardless of the SPP values until complete wound healing was obtained. Time to wound healing and complete wound healing rates were compared between the two groups. Results: No significant differences existed in baseline patients and lesion characteristics between the two groups. There was no significant difference in total EVT numbers between the two groups (2.0; interquartile range, 2.0-3.0 versus 2.0; interquartile range, 2.0-3.0; P=0.9). Although complete wound healing rate was similar in both groups (71.2% versus 73.0%, p=1.0), time to wound healing was significantly shorter (95 days versus 143 days, p =0.025) in the Planned-EVT-group than in the Conventional-EVT-group. Conclusions: Planned-EVT is a useful strategy to shorten the time to wound healing for CLI patients with tissue loss.