Wound Healing After Angiosome-Directed Revascularization in CLI With Concomitant Femoropopliteal Paclitaxel Intervention

Purpose: To report a retrospective cohort analysis of wound-healing rates in patients with chronic non-healing wounds treated with femoropopliteal pacliaxel endovascular technology and concurrent tibial artery balloon angioplasty. Materials and Methods: Forty-four consecutive patients with critical limb ischemia and associated non-healing wounds (RutherfordV-VI) underwent tibial artery balloon angioplasty with concomitant femoropopliteal paclitaxel eluting stent (DES) implantation or angioplasty with paclitaxel-coated balloons (DCB). Patients were followed after their initial procedure for wound healing, defined as complete healing of the index wound documented at subsequent inpatient or outpatient visits at 3-, 6-, and 12-month intervals. Results: The rate of wound healing increased over the follow-up period. At 3 months, the proportion of patients with wounds was greater than the proportion whose wounds had healed (79.5% vs 20.5%;P<.0001). At 6 months,the rate of healed patients were not statistically different from non-healed patients (43.2% vs 56.8%; P=.2046). Finally after 12 months of follow-up, the rate of healed wounds was greater than non-healed patients (68.2% vs 31.8%;P=.0007). Angiosome directed tibial artery angioplasty was found to be associated with a higher rate of wound healing compared with non-angiosome directed angioplasty (83.3% vs 50%; P=.001). Cox regression analysis revealed that patients treated via a non-angiosome directed approach were less likely to experience wound healing by 12 months (adjusted hazard ratio 3.481; P=.039). Lesion length and recurrent target lesions were not associated with restenosis. Wound classification according to the Society forVascular Surgery Lower Extremity Guidelines Committee was not found to be influential over the rates of wound healing. The effect of femoropopliteal intervention with either DES or DCB was not significantly associated with wound healing (hazard ratios 1.661 vs 1.584; P-values 0.676 vs 0.631, respectively). Conclusions: These findings are consistent with previous studies that have shown that angiosome-directed therapy is a valuable treatment strategy in patients undergoing endovascular revascularization for the treatment of non-healing arterial ulcers. Patients treated with an angiosome-directed angioplasty approach have higher rates of wound healing after 1 year.