Longitudinal changes in skin perfusion pressure after endovascular therapy in patients with chronic limb-threatening ischemia

Purpose: The skin perfusion pressure (SPP) increases after endovascular treatment (EVT) for up to 1 month, although changes beyond 1 month remain unreported. This study aimed to investigate the changes in the SPP over time after EVT.Materials and methods: This was a single-center, prospective, observational study. We included patients with chronic limb-threatening ischemia who underwent EVT between January 2019 and July 2022. We evaluated the SPP after EVT monthly for up to 3 months and compared the changes in the SPP between patients with different comorbidities. Moreover, we investigated the independent predictors of recurrent foot ischemia using a multivariate analysis.Results: Overall, 87 patients were included in the study. The mean preprocedural dorsal and plantar SPP was 33.9 +/- 14.7 and 33.4 +/- 13.1 mmHg, respectively. After the procedure, the SPP significantly increased at 1 month but decreased during months 2 and 3 (the dorsal SPP at 1, 2, and 3 months was 59.6 +/- 20.3, 48.3 +/- 20.9, and 39.7 +/- 14.7, respectively, p < 0.01; the plantar SPP at 1, 2, and 3 months was 57.3 +/- 18.2, 48.2 +/- 15.6, and 40.5 +/- 15.3, respectively, p < 0.01). Changes in the SPP did not differ among patients with different comorbidities. The multivariate analysis revealed that severe infrapopliteal calcification was an independent predictor of recurrent foot ischemia (odds ratio, 3.8; 95% confidence interval, 1.1-13.4; p = 0.04).Conclusion: The SPP after EVT significantly increased at 1 month and decreased monthly for up to 3 months. Severe infrapopliteal calcification was the sole predictor of foot ischemia recurrence. Meticulous follow-up after EVT and regular hemodynamic examinations are important.