title: Impact of angiosome-oriented revascularization on clinical outcomes in critical limb ischemia patients without concurrent wound infection and diabetes.
abstract: OBJECTIVE
  To investigate the impact of angiosome-oriented revascularization on clinical outcomes in critical limb ischemia (CLI) patients excluding those with both diabetes and wound infection.
  
  
  METHODS
  Using a retrospective multicenter database, a propensity score matching analysis was performed of 539 consecutive CLI patients (375 men; mean age 71±11 years) without concurrent wound infection and diabetes who underwent balloon angioplasty of isolated infrapopliteal lesions. Propensity score matching produced 2 groups of 182 patients each who underwent angiosome-oriented direct revascularization (123 men; mean age 72±11 years) or indirect revascularization (125 men; mean age 72±11 years). The groups were compared for wound healing rate, freedom from major adverse limb events (MALE), and amputation-free survival (AFS).
  
  
  RESULTS
  In the overall population, indirect revascularization was performed in 36.6% (n=197). In the propensity matching analysis, the complete wound healing rate at 12 months was higher in the direct group than the indirect revascularization patients (75% vs. 64%, p=0.01), while freedom from MALE (p=0.99) and AFS (p=0.17) were not significantly different at up to 24 months. In multivariate analysis, indirect revascularization had an independent negative impact on wound healing (adjusted hazard ratio 0.7, p=0.008).
  
  
  CONCLUSIONS
  After propensity matching analysis for CLI patients other than those with both diabetes and wound infection, the wound healing rate was higher after direct revascularization than after indirect revascularization, whereas MALE and AFS were not significantly different.
authors.affiliation: 1 Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Takahara
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Soga
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Yamauchi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.forename: Junichi
authors.initials: J
authors.lastname: Tazaki
authors.forename: Terutoshi
authors.initials: T
authors.lastname: Yamaoka
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Suematsu
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shintani
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miyashita
authors.forename: Masaaki
authors.initials: M
authors.lastname: Uematsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D016638:Critical Illness; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007564:Japan; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011150:Popliteal Artery / Q000503:physiopathology; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
keywords: amputation; angiosome; balloon angioplasty; critical limb ischemia; diabetes; endovascular therapy; infection; infrapopliteal arteries; propensity matching analysis; reintervention; revascularization; ulcer; wound healing