Revascularization for Wound Healing: Are Endovascular Techniques as Good as Open Bypass?

Richard F. Neville, MD, Niten Singh, MD, Tahir Jamil, BS, James Laredo, MD, David Deaton, MD, Christopher Attinger, MD.
Georgetown University, Washington, DC, USA.

Objectives: Endovascular therapy plays an increasing role in lower extremity revascularization. This study focuses on tissue endpoints after endovascular techniques (EV) or open bypass (LEB) to determine if procedural success translates into equivalent wound healing and limb salvage.
Methods: A retrospective review documented revascularization, wound care, and tissue outcome from a single-center wound program. Demographic data, treatment modality, wound size, healing progress, and amputations were noted.
Results: There were 113 procedures for ischemic wounds; 37 EV and 76 LEB (58 vein, 18 PTFE/DVP). EV treatment of SFA (n=25), popliteal (n=13), and tibial lesions (n=27) included angioplasty (n=7), stent deployment (n=19), cryoplasty (n=4), and atherectomy (n=7). Average initial wound size was 13.9mmEV and 14.3mmLEB (p=NS). Wounds were stratified by initial size and analyzed by life table analysis for percent complete healing and time to healing.


Group (initial wound size)	LEB	EV
A (0- 5mm)	86% 89days	50% 112days
B (5- 20mm)	82% 98days	31% 132days
C ( >20mm)	71% 120days	25% 172days

Healing occurred in 81%LEB and 35%EV (p=0.013) with the difference greatest in larger wounds (Group C, 71%LEB, 25%EV). LEB had a shorter median time to total healing (LEB96days, EV118days, p= 0.048). There were 12 amputations during follow-up; 8 EV (1AKA,3BKA,1TMA,3ray) and 4 LEB (2BKA,1TMA,1ray).
Conclusion: This study compares EV and LEB in terms of final tissue outcome. The results suggest more complete healing and a faster rate of healing with LEB. Prospective trials are justified to identify patients best treated with EV or LEB to achieve optimal wound healing and limb salvage.

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