Researchers find LEB or EV demonstrates faster rate of healing for larger wounds

Researchers from Georgetown University Hospital in Washington, DC have found that wound healing after lower extremity bypass (LEB) or endovascular revascularization (EV) demonstrated a more complete and faster rate of healing for larger wounds of more than 2 cm after open bypass. Findings will be presented at the 64th Vascular Annual Meeting presented by the Society for Vascular Surgery, June 10 in Boston.

Their study reviewed the records of 142 LEB patients and 148 EV patients between January 2004 and December 2008. "When comparing EV to LEB there was no difference in average initial wound size (EV 14.1mm, LEB 14.6mm) and there was equivalent healing between the two groups with 76 percent of wounds healed after LEB and 41 percent after EV," said Richard F. Neville, MD, chief of the hospital's Division of Vascular Surgery. "However," said Dr. Neville, "there was a difference in the healing rate for larger wounds, with complete healing in 70 percent of LEB patients and 27 percent of EV patients."  

Researchers added that overall there also was a shorter median time to healing after bypass of 98 days for LEB patients and 132 days for EV patients. In addition, the LEB had 10 amputations (7 percent of the total, of which 2.8 percent were major); while the EV group had 30 amputations (20 percent of the total, of which 8 percent were major).  

"Our patients had a similar average age (EV, 70 years and LEB, 71 years)," said Dr. Neville. "with similar rates of diabetes mellitus (EV 58 percent, LEB 41 percent) and chronic renal failure (EV 24 percent, LEB 21 percent)."

Researchers added that the EV procedures included 20 balloon angioplasties, 82 stent deployments, 30 atherectomies and 10 cryoplasties. Lesions treated in the lower extremity were found in the superficial femoral arteries (30 percent), and popliteal (19 percent) and tibial (51 percent) arteries with 2.8 lesions treated per patient. The LEB patients included 98 vein grafts and 44 using polytetrafluoroethylene (PTFE) with a distal vein patch. Target arteries included 14 below knee popliteal, 46 anterior tibial, 41 posterior tibial and 41 peroneal.

"We are trying to determine the most appropriate scenarios for bypass and endovascular therapy, and our study demonstrated that initial wound size may be a consideration in choosing the method of revascularization for ischemic wounds," noted Dr. Neville.