Importance of Pedal Microcirculation to Wounds for Wound Healing After Bypass Surgery in Chronic Limb-threatening Ischemia

In the treatment of chronic limb-threatening ischemia (CLTI), complete wound healing is an important goal. Although foot perfusion status seems to be for healing, global limb anatomic staging system (GLASS) Global Vascular Guidelines (GVG) does not include pedal artery process due lack sufficient evidence its importance. This study aimed clarify importance after bypass surgery. Among 153 CLTI cases that underwent distal popliteal arteries from 2014 2018, 117 limbs with wounds and angiographic data were enrolled. They classified into two groups, based on 6 months postoperatively; early group (n = 78), which achieved within postoperatively, prolonged or unhealed 39), failed achieve months. Various factors associated including wound, ischemia, infection (WIfI) classification, graft flow, data, analyzed. Regarding in addition GLASS inframalleolar/pedal disease descriptor (GLASS-IPD), newly formed classification microcirculatory association location was included: groups as visualized micro-arteries towards (visualized perfusion) barely (barely (Fig 1). Univariate analysis showed preoperative albumin (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.24-0.94; P .027), higher WIfI clinical stage (OR, 3.88; CI, 1.74-10.1; .0005), GLASS-IPD 2.16; 1.16-4.02; .012), 5.74: 2.45-14.0; < .0001) significant healing. Multivariate 5.04; 1.74-14.6; .0029) 4.34; 1.71-11.0; .0021) significant, whereas detected significant. flow significantly it lower P2 than P0/P1, similar between wounds, suggesting distribution blood supply would more total amount micro-circulatory environment Pedal anatomical decision making treatment.