Document Detail


Factors influencing wound healing of critical ischaemic foot after bypass surgery: is the angiosome important in selecting bypass target artery?
MedLine Citation:
PMID:  22237509     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of the study is to determine factors affecting ischaemic wound healing and role of the angiosome concept in bypass surgery.
DESIGN: Single-centre, retrospective clinical study.
MATERIALS AND METHODS: A total of 249 consecutive critical ischaemic limbs with tissue loss in 228 patients who underwent distal bypasses from 2003 to 2009 were reviewed. A total of 81% of patients were diabetic, and 49% of patients had dialysis-dependent renal disease (end-stage renal disease, ESRD). Distal targets of bypasses were the crural artery (57%) and the pedal artery (43%).
RESULTS: The complete healing of ischaemic wounds was achieved in 211 limbs (84.7%). ESRD (odds ratio (OR) 0.127, p < 0.001), diabetes (OR 0.216, p = 0.030), Rutherford category 6 (R6) with heel ulcer/gangrene (OR 0.134, p < 0.001), R6 except heel (OR 0.336, p = 0.025) and low albuminaemia (OR 0.387, p = 0.049) were negative predictors of wound healing. Regarding the angiosome, the healing rate in the indirect revascularisation (IR) group was slower than in the direct revascularisation (DR) group, especially in patients with ESRD (p < 0.001). However, the healing rates of the DR and IR groups were similar after minimising background differences with propensity score methods (p = 0.185).
CONCLUSIONS: In the field of bypass surgery, the angiosome concept seems unimportant, at least in non-ESRD cases. The location and extent of ischaemic wounds as well as co-morbidities may be more relevant than the angiosome in terms of wound healing.
Authors:
N Azuma; H Uchida; T Kokubo; A Koya; N Akasaka; T Sasajima
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Publication Detail:
Type:  Journal Article     Date:  2012-01-09
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  43     ISSN:  1532-2165     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-06     Completed Date:  2012-04-16     Revised Date:  2013-02-28    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  322-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Asahikawa Medical University, 2-1 Midorigaoka-higashi, Asahikawa, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Amputation / statistics & numerical data
Arterial Occlusive Diseases / epidemiology,  physiopathology,  surgery*
Arteries / surgery*
Blood Vessel Prosthesis
Comorbidity
Diabetes Mellitus / epidemiology
Disease-Free Survival
Female
Foot / blood supply*,  physiopathology
Foot Ulcer / epidemiology
Gangrene / epidemiology
Humans
Ischemia / epidemiology,  physiopathology*,  surgery*
Kidney Failure, Chronic / epidemiology
Limb Salvage / methods*
Male
Middle Aged
Postoperative Care / methods
Retrospective Studies
Survival Rate
Treatment Outcome
Vascular Surgical Procedures / methods,  mortality
Wound Healing*
Comments/Corrections
Comment In:
Eur J Vasc Endovasc Surg. 2013 Jan;45(1):99   [PMID:  23116989 ]
Eur J Vasc Endovasc Surg. 2013 Jan;45(1):99-100   [PMID:  23116987 ]
Eur J Vasc Endovasc Surg. 2012 Jul;44(1):105   [PMID:  22546642 ]
Eur J Vasc Endovasc Surg. 2012 Jun;43(6):729   [PMID:  22520633 ]

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