Orthopaedic Surgery (Sep 2024)

Combining Tibial Cortex Transverse Transport (TTT) and Endovascular Therapy (EVT) for Limb Salvage in Chronic Limb‐Threatening Ischemia

  • Yi Ding,
  • Dapeng Yu,
  • Haoheng Huang,
  • Xiao Peng,
  • Shenghui Yang,
  • Zhanming Lin,
  • Peiling Zhou,
  • Jilin Liang,
  • Xiaochong Zou,
  • Ruiqing Mo,
  • Kaixiang Pan,
  • Puxiang Zheng,
  • Xiaocong Kuang,
  • Xinyu Nie,
  • Qikai Hua

DOI
https://doi.org/10.1111/os.14222
Journal volume & issue
Vol. 16, no. 9
pp. 2132 – 2139

Abstract

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Objective The clinical management of patients with chronic limb‐threatening ischemia (CLTI) faces great challenges. Enhancing wound healing and limb preservation rates in this cohort is a critical objective. This study investigates the effectiveness of combining tibial cortex transverse transport (TTT) and endovascular therapy (EVT) for the treatment of patients with severe CLTI. We aim to evaluate the therapeutic results of this combined approach on the specified patient group. Methods We conducted a retrospective study to compare EVT with the combination of TTT and EVT in patients (Rutherford category 5 and above) with CLTI at Guangxi Medical University's First Affiliated Hospital from June 2017 to June 2023. This cohort was subjected to a follow‐up period ranging from a minimum of 6 months to a maximum of 12 months. The primary outcome measures included amputation‐free survival (AFS) (avoidance of above‐ankle amputation or death from any cause), overall mortality, limb salvage rates, wound healing efficiency, and the technical efficacy of the applied treatments. A variety of statistical analyses including chi‐square tests, Fisher's exact tests, and Pearson's and Spearman's correlation analyses. Results In this study, 131 patients with CLTI were included: 76 in the control group receiving only EVT treatment and 55 in the TTT + EVT group. The two groups were matched on demographic and clinical characteristics. In the TTT + EVT group, after more than 6 months of follow‐up, 85.5% of patients achieved AFS, and wound healing was observed in 54.5% (30 of 55 patients). After more than 12 months of follow‐up, 81.9% achieved AFS, with wound healing in 32 patients. Furthermore, after more than 24 months, 74.2% of patients remained amputation‐free, with wound healing in all surviving patients. In the control group, after more than 6 months of follow‐up, 72.4% of patients achieved AFS, and wound healing was observed in 51.3% (39 of 96 patients). After more than 12 months, 48.9% achieved AFS, with wound healing in 21 patients. Conclusion We found that combining therapy of TTT and EVT is safe and can be successfully administered in patients with CLTI and it enhances wound healing and AFS.

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