Clinical Effect of Planned Repeat Endovascular Therapy for Critical Limb

Ischemia Patients with Tissue Loss

Tsuyoshi Nakata, MD

Morinomiya Hospital

Osaka, Japan

Disclosure

Speaker name:

Tsuyoshi Nakata

I have the following potential conflicts of interest to report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interest✔

Background

Restenosis; 70% @ 3month Wound healing; 50% @ 3month

✓ In CLI patients, 70% lesions were occluded within 3months after EVTs.

✓ Only 50% patients who underwent EVT were obtained complete wound healing at 3months.

✓ Clinical frailty become worse during wound treatment.

Iida O et al. Eur J Vasc Endovasc Surg. 2012 Iida O et al. Circ Cardiovasc Interv.2103

Our treatment GOAL

Delayed or incomplete wound healing adversely affects patients’ quality of life and impedes social rehabilitation.

From limb salvage to Walking Salvage

How to manage the vessels after EVTs.

✓How to assess the lesion ischemia will you

examine?

✓When will you perform revascularization for

patients with tissue loss?

Before SPP values decreaseBefore vessel occlusion

Purpose

The aim of this study was to investigate the clinical effect of repeat EVT in CLI patients.

Patients with foot tissue loss238 limbs (169 patients)

Finally, 89 limbs of 76 patients were considered to be eligible in this study.

149 limb (93 patients) were healed after first EVT.

MethodsJan 2013-Oct 2016

2013.1 2016.1 2016.10

52limbs 37limbs

Phase 1; Conventional EVTDelayed wound healing and/or decrease SPP values

Phase 2; Planned EVTEVT before decreasing SPP values

Definition and Phase course

Conventional-EVT

(n=43)

Planned-EVT

(n=33) p value

Age, yrs

Body mass index

Male gender, %

Hypertension, %

Dyslipidemia, %

Diabetes mellitus, %

Current smoker, %

Hemodialysis, %

Medication

Aspirin, %

Clopidogrel, %

Cilostazol, %

Anticoagulant, %

73 9

21.2 3.1

27 (62)

30 (70)

19 (44)

26 (60)

18 (42)

26 (60)

20 (47)

24 (56)

20 (47)

7 (16)

73 12

21.1 3.7

24 (73)

28 (85)

16 (48)

24 (73)

17 (52)

26 (79)

21 (64)

16 (48)

12 (36)

5 (15)

0.85

0.79

0.82

0.59

1.00

0.81

0.82

0.33

0.36

0.25

0.36

1.00

Baseline patients characteristics

Values are given as n (%) or mean standard deviation.

Limb characteristicsConventional-EVT

(n=52)

Planned-EVT

(n=37)

p value

Right/Left

Rutherford class 5/6

Ulcer Location

Toe

Dorsum

Planter

Heel

Wound infection

21(40)/31(60)

43(83)/9(17)

49(94)

11(21)

11(21)

5(10)

36(69)

21(57)/16(43)

31(84)/6(16)

35(95)

9(24)

8(22)

3(8)

18(49)

0.14

1.0

1.0

0.80

1.0

1.0

0.078

Values are given as n (%).

Lesion characteristicsConventional-EVT

(n=52)

Planned-EVT

(n=37)

p value

Culprit lesions

AI plus FP plus BK lesions

FP plus BK lesions

BK lesions

Run off vessels before EVT

0/ 1/ 2/ 3

Median Run off vessels before EVT

Run off vessels after EVT

0/ 1/ 2/ 3

Median Run off vessels after EVT

Total EVT number

6(12)

26(50)

20(38)

13/ 28/ 11/ 0

1,IQR,0.75-1.0

0/ 8/ 38/ 6

2,IQR,2-2

2,IQR,2-3

1(3)

22(59)

14(38)

17/ 17/ 3/ 0

1,IQR,0-1

0/ 10/ 14/ 13

2,IQR,1-3

2,IQR,2-3

0.23

0.40

1.00

0.08

0.02

0.003

0.38

0.90

Values are given as n (%) or mean standard deviation. IQR; interquartile rangeAI; Aorto-iliac. FP; Femoro-popliteal. BK; Blow the knee.

0 3 6 12

0

20

40

60

80

100

Months

Pro

po

rtio

n o

f u

lce

rs h

eal

ed

(%

)

9

Wound healing rate

Conventional-EVT

Planned-EVT

Wound healing rateconventional (37/52 71.2%)planed (27/37 73.0%) (P=1.0)

Conventional-EVT

100

200

300

400Ti

me

to

wo

un

d h

eal

ing

(Days)

P=0.0245

143 days vs 95 days

Time to complete wound healing periods

Planned-EVT

There was no significant difference in total EVT numbers between both groups

Case (Rutherford 6)

EVT for BTK 1st

Open planter aponeurosis and amputate toe after EVT

Re-EVT 2nd (28days)

Re-EVT 3rd (50days)

2016/10/5

2017/1/12

Complete healing(97days)

28days 50days 97days

1st EV

T

2n

d EV

T

3rd

EVT

Conclusion

Planned-EVT was useful in CLI patients with

tissue loss to be shorter on their wound healing.

Clinical Effect of Planned Repeat Endovascular Therapy for Critical Limb

Ischemia Patients with Tissue Loss

Tsuyoshi Nakata, MD

Morinomiya Hospital

Osaka, Japan