Abstract 16520: Association Between Blush Grade and Wound Healing or Amputation in Critical Limb Ischemia
Background: Percutaneous endovascular intervention (PEI) of below-the-knee arteries is the first-line approach for treatment in critical limb ischemia (CLI). However, intraprocedural predictors of outcomes in CLI have not been established. We aimed to investigate the role of blush grade in predicting wound healing and amputation in patients undergoing PEI for CLI.
Methods: This study is a retrospective analysis of data of consecutive patients who underwent PEI for CLI and had follow-up for outcomes between January 2011 and December 2014 at the MedStar Washington Hospital Center in Washington, DC. Blush grade was defined as the percent value of blush on the wound area compared to the blush on an area supplied by normal blood flow. The patients were classified into two groups (Group I: blush grade ≥50% [n=26] vs. Group II: <50% [n=28]) and examined wound healing at 6 month and amputation.
Results: A total of 54 patients were included in the present study. Blush grade was ≥50% in 26 patients and <50% in 28. Participants had a high prevalence of male sex (72%), diabetes (74%), hypertension (98%), hyperlipidemia (94%), hemodialysis (24%), and previous diagnosis of peripheral arterial disease (74%). No significant differences in the prevalence of these variables were shown between groups. Angiosome-based treatment was performed for the majority of patients, without significant difference between groups (88.5% in Group I vs. 85.7% in Group II, p=1.0). Direct flow to wound could be obtained more frequently in Group I (76.9% vs. 21.4%, p<0.001). Wound healing within 6 month was observed in 65.4% in Group I compared with 10.7% in Group II (p<0.001). Rates of amputation were 15.4% and 57.1%, respectively (p=0.001), with longer time-to-amputation in Group I compared with Group II (403.52±337.55 vs. 233.16±267.89, respectively; p=0.044). On multivariable analysis, a blush grade ≥50% was an independent predictor of wound healing (RR 0.051, 95% CI: 0.008-0.319, p=0.001) and amputation free survival (RR 4.12, 95% CI: 1.206-14.755, p=0.024).
Conclusion: Our single-center data indicate that blush grade is an independent intraprocedural predictor of wound healing and amputation in patients with CLI.
Author Disclosures: W. Kang: None. U. Campia: None. N.L. Bernardo: None. R. Didier: None. S. Negi: None. S. Kiramijyan: None. E. Koifman: None. N. Baker: None. M. Lipinski: None. R. Escarcega: None. R. Torguson: None. R. Waksman: None.
- © 2015 by American Heart Association, Inc.