title: Predictors of non-healing in patients with critical limb ischemia and tissue loss following successful endovascular therapy.
abstract: OBJECTIVE
  To evaluate the predictors of non-healing in patients with critical limb ischemia (CLI) after successful endovascular therapy (EVT).
  
  
  BACKGROUND
  Occasionally, wound healing in patients with CLI and tissue loss cannot be achieved even after successful EVT. Patient's co-morbidities, vascular anatomy, wound features, and interventional strategies/outcomes are associated with the probability of wound healing.
  
  
  METHODS
  Between April 2007 and October 2012, 182 patients with CLI (220 limbs) with tissue loss were treated with EVT in our institute. Of these, 164 individual wounds (130 patients, 149 limbs) out of 243 individual wounds were successfully treated. Successful EVT was defined as revascularization by achieving visible blood flow to the wounds, as evaluated by digital subtraction angiography performed just after EVT. A Cox proportional hazards model was used to analyze predictors associated with wound healing.
  
  
  RESULTS
  The mean follow-up period was 23±18 months. The wound healing rates were 40.2%, 57.3%, 62.2%, and 70.7% at 3, 6, 9, and 12 months, respectively. Multivariate Cox proportional hazards analysis revealed that insulin use [hazard ratio (HR), 0.541; 95% confidence interval (CI), 0.329-0.890; P=0.016], dependence on hemodialysis [HR, 0.429; 95% CI, 0.272-0.678; P<0.001], and major tissue loss [HR, 0.460; 95% CI, 0.294-0.720; P=0.001] were independent predictors of non-healing after successful EVT.
  
  
  CONCLUSIONS
  Insulin use, dependence on hemodialysis, and major tissue loss were independent predictors of non-healing after successful EVT.
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Nakano
authors.forename: Toshiya
authors.initials: T
authors.lastname: Muramatsu
authors.forename: Reiko
authors.initials: R
authors.lastname: Tsukahara
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishimori
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamawaki
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.forename: Tamon
authors.initials: T
authors.lastname: Kato
mesh_terms: D000368:Aged; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000175:diagnosis* / Q000628:therapy; D013997:Time Factors; D014945:Wound Healing
keywords: critical limb ischemia; endovascular therapy; wound healing