The “Woundosome” Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia

Lorenzo Patrone*, Edoardo Pasqui, Michael S. Conte, Alik Farber, Roberto Ferraresi, Matthew Menard, Joseph L. Mills, John Rundback, Peter Schneider, August Ysa, Kumar Abhishek, George L. Adams, Naseer Ahmad, Irfan Ahmed, Vlad A. Alexandrescu, Max Amor, David Alper, Martin Andrassy, Christopher Attinger, Andy BaadhHashem Barakat, Lukla Biasi, Theodosios Bisdas, Zagum Bhatti, Erwin Blessing, Marc P. Bonaca, Stefano Bonvini, Michel Bosiers, Andrew W. Bradbury, Robert Beasley, Christian Alexander Behrendt, Marianne Brodmann, Gonzalo Cabral, Roberto Cancellieri, Andrea Casini, Venita Chandra, Emiliano Chisci, Omar Chohan, Edward T.C. Choke, Patrick F.S. Chong, Giacomo Clerici, Raphael Coscas, Mary Costantino, Luca Dalla Paola, Sabeen Dand, Robert S.M. Davies, Mario D’Oria, Athanasios Diamantopoulos, Sebastian Debus, Koen Deloose, Costantino Del Giudice, Gianmarco de Donato, Brian De Rubertis, Jean Paul De Vries, Nuno V. Dias, Larry Diaz-Sandoval, Florian Dick, Konstantinos Donas, Anahita Dua, Fabrizio Fanelli, Stefano Fazzini, Mazin Foteh, Roberto Gandini, Mauro Gargiulo, Luca Garriboli, Elizabeth A. Genovese, Edward Gifford, Yann Goueffic, Peter Goverde, Prem Chand Gupta, Robert Hinchliffe, Andrew Holden, Kim C. Houlind, Dominic P.J. Howard, Bella Huasen, Giacomo Isernia, Konstantinos Katsanos, Barry Katzen, Philippe Kolh, Igor Koncar, Grigorios Korosoglou, Prakash Krishnan, Thomas Kroencke, Miltiadis Krokidis, Arun Kumarasamy, Paul Hayes, Osamu Iida, Enrique Alejandre Lafont, Ralf Langhoff, Alexandre Lecis, Mark Lessne, Hady Lichaa, Michael Lichtenberg, Marta Lobato, Alice Lopes, Giorgio Loreni, Pierleone Lucatelli, Sreekumar Madassery, Lieven Maene, Marco Manzi, Martin Maresch, Jay Santhosh Mathews, James McCaslin, Antonio Micari, Stefano Michelagnoli, Bruno Migliara, Robert Morgan, Luis Morelli, Daniele Morosetti, Nicolas Mouawad, Paul Moxey, Stefan Müller-Hülsbeck, Jihad Mustapha, Tatsuya Nakama, Bahaa Nasr, Zola N’dandu, Richard Neville, Elias Noory, Joakim Nordanstig, Katariina Noronen, Luis Mariano Palena, Gianbattista Parlani, Ashish S. Patel, Parag Patel, Rafiuddin Patel, Sanjay Patel, Costantino Pena, Drazen Perkov, Mark Portou, Giovanni Pratesi, Christos Rammos, Jim Reekers, Vicente Riambau, Trisha Roy, Kenneth Rosenfield, Maria Antonella Ruffino, Fadi Saab, Athanasios Saratzis, Paolo Sbarzaglia, Andrej Schmidt, Eric Secemsky, Michael Siah, Henrik Sillesen, Gioele Simonte, Marc Sirvent, Jill Sommerset, Sabine Steiner, Ahmed Sakr, Dierk Scheinert, Mehdi Shishebor, Stavros Spiliopoulos, Alessio Spinelli, Konstantinos Stravoulakis, Gergana Taneva, Desarom Teso, Joerg Tessarek, Selva Theivacumar, Anish Thomas, Shannon Thomas, Narayan Thulasidasan, Giovanni Torsello, Ramesh Tripathi, Nicola Troisi, Srini Tummala, Venkat Tummala, Christopher Twine, Raman Uberoi, Alessandro Ucci, Domenico Valenti, Jos van den Berg, Daniel van den Heuvel, Isabelle Van Herzeele, Ramon Varcoe, Melina Vega de Ceniga, Frank J. Veith, Maarit Venermo, Badri Vijaynagar, Sanjiv Virdee, Conrad Von Stempel, Michiel T. Voûte, Kak Khee Yeung, Thomas Zeller, Hany Zayed, Miguel Montero Baker

*Corresponding author for this work

Research output: Contribution to journalEditorialResearchpeer-review

6 Citations (Scopus)

Abstract

This editorial assembles endovascular specialists from diverse clinical backgrounds and nationalities with a global call to address key challenges to enhance revascularization in chronic limb-threatening ischemia (CLTI) patients.

Dedicated below-the-ankle (BTA) angiography and revascularization is underutilized in ischemic foot treatment. Existing guidelines do not address comprehensive BTA vessel analysis. CLTI trials also often lack data on in-line arterial flow to the ischemic lesion and BTA vessel evaluation, hindering outcome assessment.

Dedicated multi-planar angiographic evaluation of the distal microcirculation is key: Direct arterial flow or good-quality collaterals are crucial in influencing wound healing and need to be assessed diligently to the level of the distal ischemic wound territory, termed “woundosome.”

An important primary emphasis of future trials should be on validating technologies and strategies for assessing tissue perfusion before, during, and after revascularization undertaken to heal tissue loss in CLTI patients. This will allow determination of a potentially significant delta in tissue perfusion prior to and following intervention at the “woundosome” level. Once changes in arterial perfusion have been identified as positively correlated to wound healing, these could serve as a much-needed novel primary technical outcome measure for patients with tissue loss undergoing surgical, hybrid, or endovascular revascularization.
Original languageEnglish
JournalJournal of Endovascular Therapy
ISSN1526-6028
DOIs
Publication statusAccepted/In press - 2024

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