title: Early-phase wound healing and long-term outcomes of a selective endovascular-first approach for treating Rutherford 5 critical limb ischemia with infrainguinal lesions.
abstract: OBJECTIVE
  To evaluate the validity of a selective endovascular-first approach for Rutherford 5 critical limb ischemia (CLI).
  
  
  METHODS
  We analyzed, retrospectively, 51 limbs in 46 patients treated for Rutherford 5 CLI with infrainguinal lesions between 2010 and 2012. Endovascular therapy (EVT) and open surgical revascularization (OSR) were performed initially in 28 and 23 limbs, respectively. The interventions were assigned according to the systemic condition and femoropopiliteal TransAtlantic Inter-Society Consensus (TASC) II classification. We investigated early wound healing rates (defined as healing within 90 days) and amputation-free survival (AFS) rates in the EVT and OSR groups.
  
  
  RESULTS
  The OSR group had more TASC D lesions (P < 0.0001). The early wound healing rate was significantly higher in the OSR group (OSR 46.1 % vs. EVT 14.3, P = 0.0205); however, the AFS rates did not differ significantly between the groups (P = 0.4031). Preoperative walking ability significantly influenced AFS (P < 0.0001).
  
  
  CONCLUSIONS
  Our selective endovascular-first approach did not worsen AFS; however, OSR yielded better early wound healing rates. Preoperative walking ability strongly influenced AFS; hence, patients with good walking ability were good candidates for primary OSR. The indications for EVT for earlier wound healing still require better clarification.
authors.affiliation: Department of Vascular Surgery, Kyushu Medical Center, Fukuoka, Japan. k_inoue@med.kyushu-u.ac.jp.|Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. k_inoue@med.kyushu-u.ac.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Vascular Surgery, Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Onohara
authors.affiliation: Department of Vascular Surgery, Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Mikasa
authors.affiliation: Department of Vascular Surgery, Kyushu Medical Center, Fukuoka, Japan.|Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Furuyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking; D014945:Wound Healing / Q000502:physiology*
keywords: Critical limb ischemia; Endovascular therapy; Peripheral artery disease; Walking ability; Wound healing