Analysis of the therapeutic effect on foot arterial angioplasty in the treatment of lower limb arteriosclerosis obliterans complicated with ischemic ulcer and influencing factors of ulcer healing
Cui Wei, Song Tao, Jin Zhaoyang, Zhang Longfei, Yu Chaowen
Department of Vascular Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
Abstract：Objective This study aimed to explore the short-term efficacy of pedal artery angioplasty (PAA) in the treatment of lower extremity arteriosclerosis obliterans complicated with foot ischemic ulcer and its effect on ulcer healing. Methods The retrospective cohort study was conducted. Forty-three patients (43 limbs) with arteriosclerosis obliterans of lower extremities complicated with foot ischemic ulcer who were admitted in the First Affiliated Hospital of Bengbu Medical College from January 2018 to March 2022 were treated with routine subknee intracavitary treatment to open the diseased vessels under the knee. Whether they were treated with PAA or not, the patients were divided into two groups. A total of 20 limbs were included in the PAA group with 12 males and 8 females, aged 59 to 77 years old, and 23 limbs were included in the conventional group with 14 males and 9 females, aged 58 to 80 years old. The observation indicators were as follows: (1) the ankle-brachial index (ABI), pain visual analogue scale (VAS) score, ulcer healing, primary patency rate, restenosis rate, amputation rate, and survival were compared between the two groups after 6-month follow-up. (2) The patients were divided into two groups in accordance with ulcer healing and non-healing six months after operation. Univariate and multivariate logistic regression analyses were used to analyze the independent risk factors of ulcer healing. Results The operation was successful in 18 cases in PAA group and 22 cases in the conventional group. No significant difference in gender, age, past history, wound infection, type of foot arch, and vessels involved below the knee was observed between the two groups (all P values >0.05). (1) In addition, no significant difference in ABI and VAS scores was found between the two groups before operation(all P values >0.05). Six months after the operation, the ABI score in PAA group was significantly higher than that in the conventional group (0.66±0.08 vs 0.57±0.07), whereas the VAS score in PAA group was lower than that in the conventional group (2 [1.00, 2.00] vs 2 [1.75, 3.00]). The differences were statistically significant (t=3.92, Z=-2.02; all P values <0.05) No ulcer recurrence, major amputation, serious complications, and death were observed in both groups. Six months after the operation, the ulcer healing rate and exemption from the small amputation rate in PAA group were 15/18 and 18/18, respectively, which were significantly higher than those in the conventional group (45.5% [10/22] and 72.7% [16/22]). The differences were statistically significant (all P values <0.05). No significant difference in the primary patency rate, restenosis rate, and patency type of inferior knee artery was found between the two groups (all P values >0.05). (2) Univariate analysis and multivariate logistic regression analysis showed that wound infection (odds ratio [OR] =15.196, 95% confidence interval [CI] 1.331-173.178), PAA treatment (OR=0.079, 95%CI 0.103-0.613), and HbA1c >7% (OR=12.553, 95%CI 1.734-90.885) were independent risk factors affecting ulcer healing (all P values <0.05). Conclusion PAA is safe and effective for the healing of lower limb arteriosclerosis obliterans complicated with ischemic ulcer, and it has evident advantages over conventional intracavitary therapy. Six months after operation, the ulcer healing rate reaches a higher level and higher rate of avoiding small amputation, which is of clinical significance.
崔巍, 宋涛, 金朝阳, 张龙飞, 余朝文. 足动脉血管成形术治疗下肢动脉硬化闭塞症合并足部缺血性溃疡的效果及溃疡愈合影响因素的分析[J]. 中华解剖与临床杂志, 2023, 28(9): 581-586.
Cui Wei, Song Tao, Jin Zhaoyang, Zhang Longfei, Yu Chaowen. Analysis of the therapeutic effect on foot arterial angioplasty in the treatment of lower limb arteriosclerosis obliterans complicated with ischemic ulcer and influencing factors of ulcer healing. Chinese Journal of Anatomy and Clinics, 2023, 28(9): 581-586.
Campia U, Gerhard-Herman M, Piazza G, et al.Peripheral artery disease: past, present, and future[J]. Am J Med, 2019,132(10):1133-1141. DOI: 10.1016/j.amjmed.2019.04.043
[2]
Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia[J]. Eur J Vasc Endovasc Surg, 2019,58(1S):S1-S109.e33. DOI: 10.1016/j.ejvs.2019.05.006
[3]
Farber A, Eberhardt RT.The current state of critical limb ischemia: a systematic review[J]. JAMA Surg, 2016,151(11):1070-1077. DOI: 10.1001/jamasurg.2016.2018
[4]
Bolton L.Peripheral arterial disease: scoping review of patient-centred outcomes[J]. Int Wound J, 2019,16(6):1521-1532. DOI: 10.1111/iwj.13232
[5]
Kirsner RS, Vivas AC.Lower-extremity ulcers: diagnosis and management[J]. Br J Dermatol, 2015,173(2):379-390. DOI: 10.1111/bjd.13953
[6]
Jung HW, Ko YG, Hong SJ, et al.Editor's choice-impact of endovascular pedal artery revascularization on wound healing in patients with critical limb ischaemia[J]. Eur J Vasc Endovasc Surg, 2019,58(6):854-863. DOI: 10.1016/j.ejvs.2019.07.034
[7]
唐文波, 高涌, 余朝文, 等. 个性化杂交手术在复杂性下肢动脉硬化闭塞症治疗中的应用价值[J].中华解剖与临床杂志,2020, 25(4): 401-405. DOI: 10.3760/cma.j.cn101202-20200427-00150Tang WB, Gao Y, Yu CW, et al.The application value of hybridization in the treatment of complicated lower extremity arteriosclerosis obliterans[J]. Chin J Anat Clin,2020,25(4):401-405. DOI: 10.3760/cma.j.cn101202-20200427-00150
[8]
van den Berg JC. Angiosome perfusion of the foot: an old theory or a new issue?[J]. Semin Vasc Surg, 2018,31(2-4):56-65. DOI: 10.1053/j.semvascsurg.2018.12.002
[9]
Meloni M, Izzo V, Giurato L, et al.Below-the-ankle arterial disease severely impairs the outcomes of diabetic patients with ischemic foot ulcers[J]. Diabetes Res Clin Pract, 2019,152:9-15. DOI: 10.1016/j.diabres.2019.04.031
[10]
Ferraresi R, Palena LM, Mauri G, et al.Interventional treatment of the below the ankle peripheral artery disease[J].PanVascular Medicine,2015,15:3205-3226.DOI:10.1007/978-3-642-37078-6_135
Iida O, Takahara M, Soga Y, et al.Impact of angiosome-oriented revascularization on clinical outcomes in critical limb ischemia patients without concurrent wound infection and diabetes[J]. J Endovasc Ther, 2014,21(5):607-615. DOI: 10.1583/14-4692R.1
[13]
Jongsma H, Bekken JA, Akkersdijk GP, et al. Angiosome-directed revascularization in patients with critical limb ischemia[J]. J Vasc Surg, 2017,65(4):1208-1219.e1. DOI: 10.1016/j.jvs.2016.10.100
[14]
Ferraresi R, Clerici G, Casini A, et al.Foot angiosomes: instructions for use[J]. Int J Low Extrem Wounds, 2020,19(4):293-304. DOI: 10.1177/1534734620954745
[15]
Nakama T, Watanabe N, Haraguchi T, et al.Clinical outcomes of pedal artery angioplasty for patients with ischemic wounds: results from the multicenter RENDEZVOUS registry[J]. JACC Cardiovasc Interv, 2017,10(1):79-90. DOI: 10.1016/j.jcin.2016.10.025
[16]
Kehagias E, Ioannou CV, Bouloukaki I, et al.Feasibility of ischemic leg ulcer healing using percutaneous techniques: a real-life study[J]. Acta Radiol, 2020,61(3):353-360. DOI: 10.1177/0284185119862955
[17]
Nakama T, Watanabe N, Kimura T, et al.Clinical implications of additional pedal artery angioplasty in critical limb ischemia patients with infrapopliteal and pedal artery disease[J]. J Endovasc Ther, 2016,23(1):83-91. DOI: 10.1177/1526602815610119
[18]
Huizing E, Schreve MA, de Vries J, et al. Below-the-ankle angioplasty in patients with critical limb ischemia: a systematic review and meta-analysis[J]. J Vasc Interv Radiol, 2019,30(9):1361-1368.e2. DOI: 10.1016/j.jvir.2019.05.001
[19]
Tsubakimoto Y, Nakama T, Kamoi D, et al.Outcomes of pedal artery angioplasty are independent of the severity of inframalleolar disease: a subanalysis of the multicenter RENDEZVOUS registry[J]. J Endovasc Ther, 2020,27(2):186-193. DOI: 10.1177/1526602820901838
[20]
Weaver ML, Hicks CW, Canner JK, et al.The Society for Vascular Surgery Wound, Ischemia, and Foot Infection (WIfI) classification system predicts wound healing better than direct angiosome perfusion in diabetic foot wounds[J]. J Vasc Surg, 2018,68(5):1473-1481. DOI: 10.1016/j.jvs.2018.01.060.
2023, Vol. 28 
