title: Influence of surgical or endovascular distal revascularization of the lower limbs on ischemic ulcer healing.
abstract: OBJECTIVE
  Our aim is to analyze the ability of distal endovascular procedures, performed as first treatment option, to promote ischemic ulcer healing.
  
  
  METHODS
  Retrospective analysis of 91 primary distal procedures, 49 (53.8%) surgical and 42 (46.2%) endovascular, performed consecutively between January 2005 and December 2007 in patients with critical limb ischemia (CLI) and ischemic ulcers. Patient comorbidities, intervention duration time, postoperative hospital stay and complications were recorded. Ischemic ulcer healing time, patency, limb salvage and survival rates were compared between both groups. Data were included in a Cox regression model to determine predictive factors for healing
  
  
  RESULTS
  Endovascular therapy was associated with shorter intervention time (128±53 versus 301±91 min; P=0.001) and postoperative hospital stay (13±13 versus 19±14 days; P=0.05). Surgical procedures were associated with more local complications (28.6% versus 7.1% P=0.01), more readmissions for surgical wound complications (12.2% versus 0% P=0.03) and more early major amputations (16.3% versus 0% P=0.007). Ischemic ulcer healing in endovascular and surgical procedures was 80% versus 83% at 12 months (P=NS). Overall patency, limb salvage, survival and amputation-free survival with healed ulcers at 24 months in endovascular and surgical groups were 82% versus 82% (P=NS), 83% versus 72% (P=NS), 81% versus 79% (P=NS) and 63% versus 56% (P=NS). Diabetes mellitus (HR: 2.86 95% CI [1.44-5.68]), free ambulatory status (HR: 0.57 95% CI [0.33-0.98]) and the presence of severe wounds (HR: 2.73 95% CI [1.40-5.30]) were predictors for ulcer healing.
  
  
  CONCLUSIONS
  Endovascular and surgical distal procedures had a similar ulcer healing rate and limb salvage. Our experience supports endovascular-first strategy for CLI with tissue loss.
authors.affiliation: Department of Angiology and Vascular Surgery, Getafe University Hospital, Madrid, Spain. Varelot@hotmail.com
authors.forename: C
authors.initials: C
authors.lastname: Varela
authors.forename: F
authors.initials: F
authors.lastname: Acin
authors.forename: J
authors.initials: J
authors.lastname: De Haro
authors.forename: J
authors.initials: J
authors.lastname: March
authors.forename: A
authors.initials: A
authors.lastname: Florez
authors.forename: A
authors.initials: A
authors.lastname: Lopez-Quintana
mesh_terms: D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000209:etiology / Q000473:pathology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D007871:Leg Ulcer / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D007902:Length of Stay; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014945:Wound Healing