Healing of Ischaemic Tissue Lesions after Infrainguinal Bypass Surgery for Critical Leg Ischaemia

Abstract Objective To evaluate healing time of ischaemic tissue lesions, limb salvage and survival in patients suffering from critical limb ischaemia (CLI) with tissue loss. Design Prospective single centre cohort study. Material and methods Consecutive patients with CLI and tissue loss (Fontaine IV) (148 patients, 150 limbs) were followed prospectively for 1 year after infrainguinal bypass. Healing time of tissue lesions, graft patency, limb salvage, survival rates and the overall need for any type of surgical and endovascular procedure were analysed. Patient comorbidities were assessed by uni- and multivariate analysis to determine risk factors for adverse outcome. Results Complete tissue healing, including healing of ischaemic tissue lesions and surgical wounds, at 6 and 12 months after the infrainguinal bypass were respectively 40% and 75%. The median time to complete tissue healing was 190 days. Diabetes was the only significant risk factor which delayed tissue healing. Overall patency, limb salvage, survival and amputation-free survival rates were respectively at 12 months 80%, 81%, 73% and 63%. The clinically important endpoint amputation-free survival with completely healed wounds was attained in 50% of patients at 1 year. Conclusion Complete healing of ischemic tissue lesions is slow even after a successful infrainguinal bypass.