Distal Bypass Improves Skin Perfusion Pressure at the Entire Foot Regardless of Angiosomes in Patients with Chronic Limb-Threatening Ischaemia

Abstract

This study evaluated the tissue blood pressure of the direct revascularised (DR) and indirect revascularised (IR) areas after distal bypass surgery using repeated skin perfusion pressure (SPP) measurements. Twenty-two patients received regular hemodialysis, and all limbs were classified as Rutherford 5. SPP of the direct and indirect revascularization area was measured at 10 time points, including pre- and post-days 3 to 6, 7 to 9, 10 to 12, 13 to 14, 15 to 17, 18 to 20, 21 to 23, 24 to 26, and 27 to 29. Patients were divided into two groups according to the number of postoperative days to the SPP peak at the DR, as follows: group A (n = 14; SPP peak day within 9 days), group B (n = 15; peak day after 10 days). In total, 446 SPP measurements were collected from 58 measurement sites, and the transition of the SPP at the DR was 35.4, 62.5, 59.5, 70.2, 58.2, 62.2, 63.1, 63.6, 63.8, and 73.4 mmHg and IR was 29.4, 53.4, 53.7, 58.8, 51.3, 63.1, 47.9, 62.1, 57.6, and 61.0 mmHg. No significant differences were observed between SPP at the DR and IR except post-days 18 to 20 (Fig 1). Fifteen wounds on the DR (62.5%) and five on the IR (100.0%) healed. The wound healing rate and time were 92.9% and 81 days in group A, 53.3% and 222 days in group B (Fig 2). Distal artery bypass improved SPP in the IR and DR of patients with chronic limb-threatening ischemia. An early SPP peak could be an indicator of wound healing.Fig 2Cumulative incidence curve of wound healing in each group. There was a significant difference in the wound healing rate (P = .01).View Large Image Figure ViewerDownload Hi-res image Download (PPT)