Ferrufino-Mérida AL, Rodríguez-Trejo JM, Escotto-Sánchez I, Rodríguez-Ramírez N

Language: Spanish
References: 34
Page: 123-134
PDF size: 259.52 Kb.

ABSTRACT

Introduction: Ischemic lesions of the foot can lead to loss of the limb and often have little chance of healing, despite surgical or endovascular revascularization successful, if the arteries that supply-target areas where the injury is settled or there revascularizan incorrect connection between the revascularized artery vascular and local ischemic zone.
Objective: To determine if the direct revascularization of the specific angiosomas is determinant in the wound healing and pain relief. To determine the artery most affected and most frequently revascularized. To compare the average time until complete healing of the wound. To determine percentage of major amputation or less and if it relates to the injured and the vessel angiosome revascularized.
Material and methods: Observational, cross correlation, descriptive, prospective study. Patients were included National Medical Center 20 November, ISSSTE, with critical ischemia of the lower extremity underwent successful endovascular infrapopliteal sector that met the inclusion criteria for the period January 2011 to March 2012. It was the subsequent follow Wound Clinic and Outpatient our institution. It was considered statistically significant when p ‹ 0.05.
Results: We evaluated 32 patients, the mean age of patients was 68.31 (SD 8.74, range 52-82) years, 18 (56.2%) were male and 43.8% (n = 14) were women, with relationship male: women of 1.3:1. Of the total, 84.38% (n = 27) were diabetic and 28 (87.5%) had hypertension, 56.25% had ex-smoking compared to 6.25% had active smoking and 43.75% (n = 14) suffered ischemic heart disease. Only 12.5% had EPOC. The limbs were classified in the two study groups, so that in 23 (72%) was carried out a direct revascularization (RD) and the remaining 9 limbs (28%) were subjected to indirect revascularization (RI) of the angiosomes ischemic. The anterior and posterior tibial artery was injured the most corresponding to a 43.75% in both cases, in the same way the angiosoma more revascularized was the tibialis anterior corresponding to 34.38% in many cases be the only trunk distal permeable. When comparing index ankle arm (ITB) halfway between the RD and RI groups by the χ² test was obtained statistical obtaining significance p = 0.013 for direct revascularization for the improvement of the ITB. Complete healing was achieved in 27 limbs (84.37%) with an average of 37.48 days, obtaining a standard deviation of 41.51 (minimum 12, maximum 150). The rate of healing (RD 100% vs. 44.44% RI) by Fisher’s exact test and χ² was highly significant (p = 0.00010). The average time until healing (21.17 RD days vs. RI 131.25 days) with a factor ANOVA showed p = 0.0000001. The cumulative proportion free amputation showed p = 0.00032. Values were obtained as z: 3.35 y p = 0.001 for the relationship between type of revascularization and relief of pain. In the logistic regression analysis were detected as important risk factors in the process of healing the age and the ex-smoking (95% CI 0.38-0.74).
Conclusions: Best results on the healing of ischemic ulcers or limb salvage and pain relief, not only depend on more or less successful revascularization, but also direct and appropriate treatment of the arteries irrigating directly lesional area, must be optimized and advanced clinical care of wounds, ultimately, may be the key to the prognosis of patients with IC, so that teams require trained, experienced and multidisciplinary.

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