Time is Tissue: Rates of Conversion from Dry to Wet Gangrene Following Lower Extremity Revascularization @AnahitaDua @ALPSlimb #ActAgainstAmputation @avsgjournal

Superb work from our colleagues at MGH under the aegis of Anahita Dua

Key Finding

Rates of Wet Gangrene were 7.7% at 30 days following revascularization with a mean time to conversion of 13.5 days.•

Take Home Message

Rates of conversion from wet to dry gangrene were 7.7% in the first 30 days after revascularization. These data should be considered by clinicians in determining appropriate follow up for gangrenous wounds after revascularization.

ABSTRACT

There is a paucity of data regarding the conversion rate from dry gangrene to wet gangrene after lower extremity revascularization. This study aimed to determine the rate of conversion from dry to wet gangrene within 30 days post-procedure in patients who underwent endovascular or open revascularization for critical limb ischemia. Secondary aims included determining the time to conversion and associated risk factors with conversion.

METHODS: A multicenter, retrospective review was performed utilizing the MGH/Brigham Healthcare System’s Research Patient Data Registry (RPDR). All adult patients who had lower extremity dry gangrene that underwent a revascularization procedure (endo, open, hybrid) from April 2002 – March 2020 were included. Patients who had no lower extremity gangrene, a concurrent amputation with the revascularization procedure, or wet gangrene on initial presentation were excluded. Univariate analysis was performed using the Fisher’s exact test and Wilcoxon rank-sum test.

RESULTS: Of the 1,518 patients identified who underwent revascularization, 194 (12.8%) patients met inclusion criteria and served as our study cohort. There were 15 (7.7%) conversions from dry to wet gangrene within 30 days post-procedure. The mean time to conversion was 13.5 ± 8.6 days. Univariate analysis did not identify any associated risk factors for conversion.

CONCLUSION: The rate of dry to wet gangrene conversion post revascularization is 7.7% within 30 days. The mean time of conversion is 13.5 ± 8.6 days.

Christopher A. Latz MD, MPH , Elizabeth Deluca , Srihari Lella MD ,Harold D. Waller MD , Charles DeCarlo MD , Anahita Dua MD, MBA , Rates of Conversion fromDry to Wet Gangrene Conversion Following Lower Extremity Revascularization,Annals of VascularSurgery(2022), doi: https://doi.org/10.1016/j.avsg.2022.01.005

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