Page 10 - Vasoclick emagazine_issue 1_Neat

Vasoclick, Edition 1 09

Primary outcome Table 1: Patient demographics 11

Initial healing of the index wound using a
conservative wound management approach. Patients Percentage (%)
11
demographics

Secondary outcomes Age 70 ± 8.4 years

Time to wound healing (time interval between Diabetes 100%
first clinic visit to no further requirement of Hypertension 97.5%

treatment) Chronic kidney 28.7%
8
Wound recurrence 8 disease (CKD)

Delayed revascularization to achieve healing 8 End-stage renal 17.2%
Failure of conservative care (after 6 weeks, index disorder (ESRD)

wound fail to heal leading to limb loss, Active smoking 15.6%
revascularization, or surgical bypass) 8 b) Risk of amputation

Very low risk : 1-year limb
8
Results loss risk of 3%
a) Patient demographics
= 50% patients
Amongst 1,113 patients prospectively enrolled in Low risk : 1-year limb loss
8
the PAVE program, 89 (122 limbs) met the risk of 8%

inclusion criteria for the conservative group.
Mean ankle-brachial index was 0.86 ± 0.31 and Moderate risk : 1-year limb
8
average TcPO measurements were 47.4 ± 17.6 loss risk of ~25% = 43%
2
mm Hg (table 1). 11 patients.

Study design Inclusion criteria Figure 1: Patient outcomes in the PAVE program with conservative approach of wound care

The Prevention of Amputation in Veterans Age: ≥ 18 years
Everywhere (PAVE) is a veteran-specific, Presence of peripheral arterial disease and 41 limbs (93.2%)
(wound healing
44 limbs (45.4%)
prospectively maintained database that includes tissue loss (wound recurrence) after reinstating
conservative
all patients with CLTI and tissue loss. 11 With mild to moderate ischemia 122 limbs 97 limbs (79.5%) management)
(Total) (Initial healing of
(transcutaneous partial pressure of oxygen the index wound)
3 limbs (3.1%)
A multidisciplinary team was also established (TcPO ) of 30-59 mmHg) (Major amputation)
2
and included PAVE coordinator, vascular An ankle-brachial index (ABI) < 0.9 25 limbs (20.5%)
surgeons, podiatrists, physiatrists, pharmacists, Absent pedal pulses (No index
wound healing)
prosthetists, nurses, infectious disease Presence of tissue loss or ulceration
specialists, and nutritionists. 7,11 Comorbidities: diabetes mellitus (DM),
Underwent 4 limbs (16%) (amputation
smoking history, hypertension (HTN), chronic revascularization due to delayed
kidney disease (CKD), and/or end-stage renal (4±4.6 months) revascularization)

disease (ESRD).
Total 7 out of 122 limbs (5.7%) were lost in the entire cohort during a mean follow up of 35.7 ± 28.4 months
(Figure 1). 11