Predictors of delayed wound healing after simultaneous endovascular treatment and minor forefoot amputation for chronic limb-threatening ischemia with wound infection

Abstract

Objectives

To assess wound healing after simultaneous endovascular treatment (EVT) and minor forefoot amputation and identify the predictors of delayed wound healing in patients with chronic limb-threatening ischemia (CLTI) and bacterial infections of the wounds.

Methods

In this single-center retrospective cohort study, we evaluated 79 consecutive limbs with tissue loss from 73 CLTI patients who underwent simultaneous EVT and minor forefoot amputation between November 2017 and May 2020. To estimate the rate of wound healing after the simultaneous procedure, we used the Kaplan–Meier method. To assess the association between baseline characteristics and delayed wound healing, we used the Cox proportional hazard model.

Results

All patients who underwent the simultaneous procedure had ischemic wounds with bacterial infection. The rate of wound healing at 6 months reached 82%. The median time for wound healing was 76 days. According to multivariable analysis, Lisfranc/Chopart amputation (hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.09–6.60), absence of above-the-knee (ATK) occlusive lesions (HR 1.89, 95% CI 1.04–3.45), and poor below-the-ankle (BTA) runoff (HR 1.77, 95% CI 1.01–3.11) were independent predictors of delayed wound healing.

Conclusion

Lisfranc/Chopart amputation, absence of ATK occlusive lesions, and poor BTA runoff were independent predictors of delayed wound healing after simultaneous EVT and minor forefoot amputation in patients with CLTI and bacterial infections of the wound.

Keywords

Chronic limb-threatening ischemia critical limb ischemia wound bacterial infection minor forefoot amputation endovascular treatment wound healing

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