Post on 28-May-2018
Clinical Effect of Planned Repeat Endovascular Therapy for Critical Limb
Ischemia Patients with Tissue Loss
Tsuyoshi Nakata, MD
Morinomiya Hospital
Osaka, Japan
Disclosure
Speaker name:
Tsuyoshi Nakata
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest✔
Background
Restenosis; 70% @ 3month Wound healing; 50% @ 3month
✓ In CLI patients, 70% lesions were occluded within 3months after EVTs.
✓ Only 50% patients who underwent EVT were obtained complete wound healing at 3months.
✓ Clinical frailty become worse during wound treatment.
Iida O et al. Eur J Vasc Endovasc Surg. 2012 Iida O et al. Circ Cardiovasc Interv.2103
Our treatment GOAL
Delayed or incomplete wound healing adversely affects patients’ quality of life and impedes social rehabilitation.
From limb salvage to Walking Salvage
How to manage the vessels after EVTs.
✓How to assess the lesion ischemia will you
examine?
✓When will you perform revascularization for
patients with tissue loss?
Before SPP values decreaseBefore vessel occlusion
Patients with foot tissue loss238 limbs (169 patients)
Finally, 89 limbs of 76 patients were considered to be eligible in this study.
149 limb (93 patients) were healed after first EVT.
MethodsJan 2013-Oct 2016
2013.1 2016.1 2016.10
52limbs 37limbs
Phase 1; Conventional EVTDelayed wound healing and/or decrease SPP values
Phase 2; Planned EVTEVT before decreasing SPP values
Definition and Phase course
Conventional-EVT
(n=43)
Planned-EVT
(n=33) p value
Age, yrs
Body mass index
Male gender, %
Hypertension, %
Dyslipidemia, %
Diabetes mellitus, %
Current smoker, %
Hemodialysis, %
Medication
Aspirin, %
Clopidogrel, %
Cilostazol, %
Anticoagulant, %
73 9
21.2 3.1
27 (62)
30 (70)
19 (44)
26 (60)
18 (42)
26 (60)
20 (47)
24 (56)
20 (47)
7 (16)
73 12
21.1 3.7
24 (73)
28 (85)
16 (48)
24 (73)
17 (52)
26 (79)
21 (64)
16 (48)
12 (36)
5 (15)
0.85
0.79
0.82
0.59
1.00
0.81
0.82
0.33
0.36
0.25
0.36
1.00
Baseline patients characteristics
Values are given as n (%) or mean standard deviation.
Limb characteristicsConventional-EVT
(n=52)
Planned-EVT
(n=37)
p value
Right/Left
Rutherford class 5/6
Ulcer Location
Toe
Dorsum
Planter
Heel
Wound infection
21(40)/31(60)
43(83)/9(17)
49(94)
11(21)
11(21)
5(10)
36(69)
21(57)/16(43)
31(84)/6(16)
35(95)
9(24)
8(22)
3(8)
18(49)
0.14
1.0
1.0
0.80
1.0
1.0
0.078
Values are given as n (%).
Lesion characteristicsConventional-EVT
(n=52)
Planned-EVT
(n=37)
p value
Culprit lesions
AI plus FP plus BK lesions
FP plus BK lesions
BK lesions
Run off vessels before EVT
0/ 1/ 2/ 3
Median Run off vessels before EVT
Run off vessels after EVT
0/ 1/ 2/ 3
Median Run off vessels after EVT
Total EVT number
6(12)
26(50)
20(38)
13/ 28/ 11/ 0
1,IQR,0.75-1.0
0/ 8/ 38/ 6
2,IQR,2-2
2,IQR,2-3
1(3)
22(59)
14(38)
17/ 17/ 3/ 0
1,IQR,0-1
0/ 10/ 14/ 13
2,IQR,1-3
2,IQR,2-3
0.23
0.40
1.00
0.08
0.02
0.003
0.38
0.90
Values are given as n (%) or mean standard deviation. IQR; interquartile rangeAI; Aorto-iliac. FP; Femoro-popliteal. BK; Blow the knee.
0 3 6 12
0
20
40
60
80
100
Months
Pro
po
rtio
n o
f u
lce
rs h
eal
ed
(%
)
9
Wound healing rate
Conventional-EVT
Planned-EVT
Wound healing rateconventional (37/52 71.2%)planed (27/37 73.0%) (P=1.0)
Conventional-EVT
100
200
300
400Ti
me
to
wo
un
d h
eal
ing
(Days)
P=0.0245
143 days vs 95 days
Time to complete wound healing periods
Planned-EVT
There was no significant difference in total EVT numbers between both groups
Conclusion
Planned-EVT was useful in CLI patients with
tissue loss to be shorter on their wound healing.