Inframalleolar status according to the Global Limb Anatomic Staging System is associated with wound recurrence after complete wound healing in patients with chronic limb-threatening ischemia.

Abstract

To determine the predictors of wound recurrence after complete wound healing in patients with chronic limb-threatening ischemia (CLTI) who underwent endovascular therapy (EVT), with particular focus on infrapopliteal (IP) and inframalleolar (IM) arterial status. This multicenter retrospective study assessed de novo limbs with CLTI and tissue loss treated with EVT including IP artery intervention from March 2021 to December 2023. Among 1094 limbs in 917 patients treated with EVT, 478 limbs that achieved complete wound healing were included in the final analysis. The Kaplan-Meier method was used to estimate the wound recurrence rate after complete wound healing. Cox proportional hazards regression models were used to assess the association between baseline characteristics, including IP and IM arterial anatomic severity, and wound recurrence. The overall wound recurrence rate was 18.8%. The mean time to wound recurrence was 7.7 ± 7.4 months. The cumulative wound recurrence rate increased stepwise according to IM grade in the Global Limb Anatomic Staging System (GLASS). The estimated wound recurrence rates at 12 months were 11.8% ± 4.2%, 19.3% ± 2.8%, and 29.6% ± 5.3% in IM grades 0, 1, and 2, respectively, with a significant difference among the groups (log-rank, P < .001). Multivariable analysis revealed that IM grade in the GLASS was the only independent predictor of wound recurrence after complete wound healing (hazard ratio, 1.65 per 1-grade increase; 95% confidence interval, 1.13-2.41; P = .009). In patients with CLTI who achieved complete wound healing after EVT, IM grade in the GLASS was the only independent predictor of wound recurrence. Poor IM arterial status may be an important determinant of wound durability after complete wound healing.