Impact of Endovascular Pedal Arch Angioplasty on Wound Healing in Patients with Lower Limb Ischemia

Abdelmawla, Mohamed H.; Gaber, Khaled E.; Emam, Usama S.; Shawky, Khaled; Algaby, Abdulaziz Z.; Abd El-Aziz, Ibrahim S.

doi:10.21608/ejmr.2025.350861.1762

Impact of Endovascular Pedal Arch Angioplasty on Wound Healing in Patients with Lower Limb Ischemia

Document Type : Original Article

Authors

General and Vascular Surgery Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt

10.21608/ejmr.2025.350861.1762

Abstract

Background: Peripheral artery disease (PAD) is the second most prevalent manifestation of atherosclerosis, impacting more than two hundred million individuals. The aim of this work was to evaluate the outcome of pedal arch angioplasty in patients with critical lower limb ischemia (LLI) on healing of tissue loss (ulcers - raw areas post-surgical debridement), time to healing, follow-up clinical improvement (rest pain) and duplex assessment of arterial system and ankle brachial index (ABI) post intervention. Methods: This prospective randomized cohort study was carried out on 40 patients aged from 30 to 80 years old, both sexes, with chronic limb threatening ischemia of Lower Limb. All patients were subjected duplex scanning and computed tomography angiography of LLs. Results: Wound condition after 1 month of follow up, three months & six months of monitoring among studied cases were statistically significant (p value less than 0.05) as percentage of cases with complete wound healing increased from 5% after 1 month to 30% following three months & then to 65% following six months of monitoring. Regarding Technical success among studied cases, the cases that had complete pedal arch revascularization with percentage of 35%, then 45% had incomplete pedal arch, while only 20% had failed pedal arch angioplasty. Conclusions: Our results showed that pedal arch angioplasty showed statistical improvement in total wound healing over follow-up periods shortening the duration of healing in Ischemic patients, improving limb salvage and quality of life.

Keywords

Main Subjects

Surgery ·

References

1. Nakama T, Watanabe N, Haraguchi T, Sakamoto H, Kamoi D, Tsubakimoto Y, et al. Clinical outcomes of pedal artery angioplasty for patients with ischemic wounds: Results from the multicenter rendezvous registry. JACC Cardiovasc Interv. 2017;10:79-90.
2. Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382:1329-40.
3. Mustapha JA, Diaz-Sandoval LJ. Management of infrapopliteal arterial disease: Critical limb ischemia. Interv Cardiol Clin. 2014;20:573-92.
4. Kobayashi N, Hirano K, Nakano M, Ito Y, Ishimori H, Yamawaki M, et al. Prognosis of critical limb ischemia patients with tissue loss after achievement of complete wound healing by endovascular therapy. J Vasc Surg. 2015;61:951-9.
5. Kawarada O, Fujihara M, Higashimori A, Yokoi Y, Honda Y, Fitzgerald PJ. Predictors of adverse clinical outcomes after successful infrapopliteal intervention. CCI. 2012;80:861-71.
6. Troisi N, Turini F, Chisci E, Ercolini L, Frosini P, Lombardi R, et al. Impact of pedal arch patency on tissue loss and time to healing in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization. Korean J Radiol. 2018;19:47-53.
7. Houghton JS. Frailty, cognitive impairment, and chronic limb-threatening ischaemia. Mod Rheumatol Case Rep. 2022;20:400-20.
8. Haine A, Haynes AG, Limacher A, Sebastian T, Saengprakai W, Fuss T, et al. Patency of the arterial pedal-plantar arch in patients with chronic kidney disease or diabetes mellitus. Ther Adv Cardiovasc Dis. 2018;12:145-53.
9. Simons JP, Goodney PP, Nolan BW, Cronenwett JL, Messina LM, Schanzer A, et al. Failure to achieve clinical improvement despite graft patency in patients undergoing infrainguinal lower extremity bypass for critical limb ischemia. JVS 2010;51:1419-24.
10. Dua A, Rothenberg KA, Lee JJ, Gologorsky R, Desai SS. Six-month freedom from amputation rates and quality of life following tibial and pedal endovascular revascularization for critical limb ischemia. Vasc Endovascular Surg. 2019;53:212-5.
11. Beckman JA, Schneider PA, Conte MS. Advances in revascularization for peripheral artery disease: revascularization in PAD. Circ Res. 2021;128:1885-912.
12. Troisi N, Guidotti A, Turini F, Lombardi R, Falciani F, Baggiore C, et al. Influence of pedal arch quality on 5-year survival and limb salvage in patients with diabetic foot ulcers undergoing peripheral angiography. Vascular. 2022;30:848-55.
13. Soliman MA, Tawfek HA, Zidan MH. Impact of foot arch status on the outcome of infra-popliteal bypasses in critical limb ischemia patients with tissue loss. The Egyptian Journal of Surgery. 2023;41.
14. Uccioli L, Gandini R, Giurato L, Fabiano S, Pampana E, Spallone V, et al. Long-term outcomes of diabetic patients with critical limb ischemia followed in a tertiary referral diabetic foot clinic. Diabetes care. 2010;33:977-82.
15. Chaudhari HK, Sumanthraj K, Anand V, Motukuru V, Rodney SR, Sravan C, et al. Comparative study of outcomes between single-vessel versus multiple-vessel infrapopliteal angioplasties in patients with chronic limb-threatening ischemia. Indian j vasc endovasc surg. 2020;7:129-35.
16. Meyer A, Schinz K, Lang W, Schmid A, Regus S, Rother U. Outcomes and influence of the pedal arch in below-the-knee angioplasty in patients with end-stage renal disease and critical limb ischemia. Ann Vasc Surg. 2016;35:121-9.
17. Higashimori A, Iida O, Yamauchi Y, Kawasaki D, Nakamura M, Soga Y, et al. Outcomes of one straight‐line flow with and without pedal arch in patients with critical limb ischemia. CCI. 2016;87:129-33.
18. Nakama T, Watanabe N, Haraguchi T, Sakamoto H, Kamoi D, Tsubakimoto Y, et al. Clinical outcomes of pedal artery angioplasty for patients with ischemic wounds: results from the multicenter rendezvous registry. JACC. 2017;10:79-90.