The Association between Toe Blood Flow Pattern Just after Pedal Artery Angioplasty and Foot Prognosis in Patients with Comprehensive Severe Chronic Lower Limb Ischemia

Abstract

　Revascularization with surgical or endovascular treatment (EVT) is an essential process for the treatment of foot ulcers and gangrene in patients with comprehensive severe chronic lower limb ischemia (CLTI). Previous studies reported that pedal artery angioplasty (PAA) is effective for wound healing; however, there are cases in which wound healing still cannot be obtained.
　We investigated the relationship between toe blood flow patterns during PAA using laser-doppler flowmetry and foot prognosis.
　Between March 2018 and June 2021, we analyzed 21 limbs (18 cases) with pedal artery angioplasty retrospectively.
　Foot prognosis was compared between improved and non-improved groups at an average of 20.4 months (± 11.8 months) .
　The rate of improved cases was 66.6% (14 of 21 sessions) . Wound healing rates in the improved and non-improved groups were 78.6% and 42.9% (p = 0.10) , unexpected additional amputations were 7.1% and 28.6% (p = 0.19) , and major amputations were 14.3% and 42.9% (p = 0.14), respectively. All-cause mortality was significantly higher in the non-improved group (14.3% vs. 71.4%, p = 0.017). Toe blood flow evaluation during PAA may be useful in predicting the foot prognosis of CLTI patients.