RS21 - Impact of Hemodynamic Success of Revascularization Measured by Skin Perfusion Pressue on Wound Healing in Chronic Limb-threatening Ischemia

Objectives: Functional revascularization is theroritically essential to overcome chronic limb-threatening ischemia (CLTI) and accomplish wound healing. The aim of this study is to figure out the impact of hemodynamic success after revascularization on wound healing, based on change of skin perfusion pressure (SPP).

Methods: This single-center retrospective study included 203 patients (256 limbs) who underwent revascularization from January 2014 to December 2019. Patient’s characteristics, limb severity by the WIfI system and the anatomical complexity by GLASS system including the inframalleolar pedal disease (IMPD) grading were preoperatively assessed. SPP was evaluated before and after the revascularization, and wound healing was determined when a wound was completely epithelialized. The study subjects were classified into the healing and non-healing group at 3 months after the revascularization.

Results: Diabetes and end-stage renal disease were included in 78.8% and 52.2%, respectively. Open bypass was representative revascularization 79.3% and endovascular therapy (EVT) was selected in 20.7%. Wound healing rate at 3 months was 51%, assigned 130 and 126 limbs as the healing and non-healing group, respectively. No difference was observed in characteristics between the two groups except preoperative WIfI stage and IMPD grading; the non-healing group were significantly higher limb severity than the healing group (P < 0.001 and 0.021 for each). Although there was no difference in preoperative SPP between two groups (27.7±9.5 vs 26.7±11.4, P=0.506), postoperative SPP significantly improved more in the healing group compared to non-healing group (52.0±15.5 mmHg vs. 45.7±15.4 mmHg, P=0.01). The optimal cutoff point for wound healing within 3 months was 37.5 mmHg. Cox regression determined wound grade, IMPD grading, diabetes and angiosome as independent factors of the SPP value after the revascularization. Compared to EVT, the difference value of SPP after open bypass surgery was more in IMPD 0, 1 and 2 (27.8 ± 11.2 vs. 18.7 ± 10.6, P=0.032; 23.3 ± 15.9 vs. 19.3 ± 13.5, P=0.278; 13.0 ± 8.2 vs. 12.0±0, P=0.902). Finally, wound healing rate reached to 79.9% and 96.1% at 6 and 12 months, respectively.

Conclusions: Hemodynamic success by revascularization plays an important role in CLTI treatment, especially for acquisition of wound healing. Open bypass surgery was more functional in postoperative improvement of SPP regardless of IMPD grading associated with wound healing, compared to EVT.