Eur J Vasc Endovasc Surg. 2026 Jan 22:S1078-5884(26)00068-7. doi: 10.1016/j.ejvs.2026.01.032. Online ahead of print.
ABSTRACT
OBJECTIVE: In patients with chronic limb threatening ischaemia (CLTI), pedal artery angioplasty (PAA) is widely known to improve wound healing, but inframalleolar revascularisation may worsen arterial lesion morphology and lead to wound recurrence after healing. This retrospective cohort study aimed to clarify the effects of PAA on wound recurrence after wound healing.
METHODS: Consecutive limbs with CLTI (n = 534) secondary to infrapopliteal and pedal artery disease that underwent endovascular therapy (EVT) and achieved complete wound healing at eight cardiovascular centres in Japan were analysed (March 2021 - December 2023). Limbs were divided into two groups according to whether PAA was performed (n = 89) or not (n = 445).
RESULTS: Propensity score matching extracted 160 matched limbs that had no remarkable intergroup differences in patient and lesion characteristics. The wound recurrence rate at 1 year was statistically significantly higher in the PAA group than in the non-PAA group (51.4% vs. 23.5%; p < .001). Low serum albumin level, haemodialysis, good pedal artery type before EVT, and low small artery disease score showed significant interaction effects on wound recurrence, favouring non-PAA over PAA. Subanalysis of changes in plantar arch artery morphology before EVT and during repeat angiography at the time of wound recurrence showed statistically significantly more frequent deterioration of plantar arch artery morphology in the PAA group than in the non-PAA group (p = .020).
CONCLUSION: This study showed a significantly higher wound recurrence rate and more frequent deterioration of plantar arch artery morphology after PAA than after a non-PAA treatment in patients with CLTI.
PMID:41580272 | DOI:10.1016/j.ejvs.2026.01.032