Impact of wound blush as an angiographic end point of endovascular therapy for patients with critical limb ischemia

Objectives: Several reports have been published of the acceptable patency and limb salvage rates after infrapopliteal interventions for the treatment of critical limb ischemia (CLI). However, the optimal angiographic end point of endovascular therapy (EVT) remains unclear. This study assessed the relationship between the appearance of wound blush as an angiographic end point and the limb salvage rate in patients with CLI. Methods: "Wound blush" was defined as contrast pacification of the vessels around the wound in digital subtraction angiograms obtained immediately after EVT through the catheter introduced into the popliteal artery. We analyzed the data of 77 consecutive patients (93 limbs) with ischemic ulcerations, classified as Rutherford category 5 or 6, who underwent EVT without bypass surgery. Patients were divided into two groups depending on whether wound blush was seen in the angiogram obtained immediately after the procedure. The freedom from amputation rate was compared between the two groups. Results: The overall limb salvage rate was 81.7%. The limb salvage rate was significantly higher in the wound blush-positive group than in the wound blush-negative group and remained so for at least 3 years after the EVT (96.4% vs 56.8%, P < .001). Conclusions: Presence of wound blush after EVT is associated with higher skin perfusion pressure, both of which are associated with higher rates of limb salvage. Wound blush as an angiographic end point in EVT may be a novel predictor of limb salvage in patients with CLI. (J Vase Surg 2012;55:113-21.)