Early-phase wound healing and long-term outcomes of a selective endovascular-first approach for treating Rutherford 5 critical limb ischemia with infrainguinal lesions

Kentaro Inoue, Toshihiro Onohara, Keita Mikasa, Tadashi Furuyama

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Purpose: To evaluate the validity of a selective endovascular-first approach for Rutherford 5 critical limb ischemia (CLI). Methods: We analyzed, retrospectively, 51 limbs in 46 patients treated for Rutherford 5 CLI with infrainguinal lesions between 2010 and 2012. Endovascular therapy (EVT) and open surgical revascularization (OSR) were performed initially in 28 and 23 limbs, respectively. The interventions were assigned according to the systemic condition and femoropopiliteal TransAtlantic Inter-Society Consensus (TASC) II classification. We investigated early wound healing rates (defined as healing within 90 days) and amputation-free survival (AFS) rates in the EVT and OSR groups. Results: The OSR group had more TASC D lesions (P < 0.0001). The early wound healing rate was significantly higher in the OSR group (OSR 46.1 % vs. EVT 14.3, P = 0.0205); however, the AFS rates did not differ significantly between the groups (P = 0.4031). Preoperative walking ability significantly influenced AFS (P < 0.0001). Conclusions: Our selective endovascular-first approach did not worsen AFS; however, OSR yielded better early wound healing rates. Preoperative walking ability strongly influenced AFS; hence, patients with good walking ability were good candidates for primary OSR. The indications for EVT for earlier wound healing still require better clarification.

Original languageEnglish
Pages (from-to)1301-1309
Number of pages9
JournalSurgery today
Issue number11
Publication statusPublished - Nov 1 2016


All Science Journal Classification (ASJC) codes

  • Surgery

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