Perfusion Assessment, Wound Evaluation, and Local Wound Care Following Angioplasty and Stenting in Peripheral Artery Disease: A Scoping Review

Abstract

Background

Lower-extremity endovascular revascularization restores macrovascular blood flow in peripheral artery disease, but technical success does not necessarily ensure adequate tissue perfusion or wound healing. Continued perfusion surveillance, wound evaluation, and local wound management are therefore required after the procedure.

Objective

This scoping review mapped evidence on post-revascularization perfusion assessment, wound evaluation, and local wound care after lower-extremity endovascular revascularization and identified nursing-relevant practices and evidence gaps.

Methods

This review followed Joanna Briggs Institute guidance and was reported in accordance with the PRISMA Extension for Scoping Reviews. PubMed/MEDLINE, Scopus, CINAHL via EBSCOhost, and ScienceDirect were searched for peer-reviewed studies published from 2021 to 2026. Two reviewers independently screened the records, assessed full texts, and charted the data. The findings were synthesized descriptively and narratively.

Results

Of 4,503 identified records, 14 studies from 12 countries met the eligibility criteria. These comprised one randomized comparative trial, eight prospective observational, registry, service-evaluation, or pilot studies, and five retrospective cohort studies. Perfusion assessments included the ankle-brachial index, duplex ultrasound, toe pressure, transcutaneous oxygen pressure, perfusion angiography, thermography, hyperspectral imaging, and positron emission tomography. The ultrasound-estimated ankle-brachial pressure index, transcutaneous oxygen pressure, toe pressure, and duplex surveillance were associated with wound-healing or limb outcomes. Evidence supporting emerging imaging and biomarker-based assessments remained exploratory. Local wound-care evidence was limited to one randomized comparison and one uncontrolled interventional study. None of the included studies directly evaluated a structured nurse-led or integrated multidisciplinary post-revascularization pathway.

Conclusion

Technical revascularization success should not be considered equivalent to complete wound recovery. The available evidence primarily concerns objective perfusion reassessment and serial wound evaluation, whereas evidence for specific local wound-care interventions and formally evaluated nurse-led or integrated multidisciplinary pathways remains limited. Prospective studies should evaluate clearly defined post-revascularization pathways using consistent clinical, nursing-sensitive, patient-centered, and economic outcomes.

Introduction

Peripheral artery disease (PAD) is a major manifestation of systemic atherosclerosis and an increasingly important global health problem. In 2015, an estimated 236.62 million adults aged 25 years or older were living with PAD worldwide, of whom approximately 72.9% resided in low- and middle-income countries.¹ PAD is associated with impaired mobility, reduced quality of life, major adverse cardiovascular events, major adverse limb events, and premature mortality.² Its most severe clinical presentation, chronic limb-threatening ischemia (CLTI), is characterized by ischemic rest pain, non-healing ulceration, or gangrene and carries substantial risks of major amputation and death.³ Contemporary multicenter registry data from 2,399 patients treated for CLTI showed a higher major-amputation rate among women than among men (9.6% vs 6.9%) and identified age older than 75 years, nephropathy, coronary artery disease, and foot infection or necrosis as factors associated with 1-year mortality.⁴ These findings underscore the poor prognosis of CLTI and the need for continued clinical assessment following revascularization.

Lower-extremity revascularization is recommended for patients with CLTI to restore arterial blood flow, minimize tissue loss, promote wound healing, relieve ischemic pain, and preserve a functional limb.^2,3 Endovascular revascularization, including balloon angioplasty and stent placement, has become an important treatment option because it can restore blood flow with lower procedural invasiveness than open surgery. Nevertheless, revascularization represents only one component of limb-preservation care. Wound healing may remain delayed because of residual or recurrent ischemia, extensive tissue loss, infection, neuropathy, pressure-related trauma, edema, poor glycemic control, malnutrition, and other patient-level factors.^2,3,5 Therefore, technical procedural success should not be regarded as equivalent to complete clinical recovery.

Post-revascularization care requires objective confirmation of sustained perfusion together with repeated assessment of the wound-healing trajectory. Recommended vascular assessments include clinical examination, the ankle-brachial index, toe pressure, transcutaneous oxygen pressure, and duplex ultrasound, selected according to the clinical presentation and reliability of each test.^2,3 In patients with threatened limbs, the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification provides a standardized framework for grading wound extent, ischemia, and foot infection and for estimating the risk of limb loss.⁶ For patients with diabetes and foot ulceration, the Intersocietal IWGDF, ESVS, and SVS guideline also emphasizes objective PAD assessment, reassessment when wounds fail to improve, and coordinated vascular and wound management.⁵ These recommendations indicate that arterial patency, tissue perfusion, wound status, and clinical outcomes should be evaluated as related but distinct dimensions of recovery.

Local wound management must continue after revascularization and may include repeated wound assessment, debridement of nonviable tissue, infection management, pressure offloading when indicated, appropriate dressings, edema control, pain management, and optimization of systemic factors affecting healing.² These activities commonly involve input from vascular specialists, wound-care professionals, podiatrists, nurses, rehabilitation professionals, and other members of the multidisciplinary team. However, the available literature has not established how responsibilities are allocated among these professionals or whether structured nurse-led or integrated multidisciplinary pathways improve wound or limb outcomes. Nursing and multidisciplinary elements were therefore treated as descriptive care components only when they were explicitly reported in the included studies.

Despite guideline recommendations, the available evidence has not been consolidated across the linked domains of perfusion reassessment, wound evaluation, local wound care, and care delivery after lower-extremity endovascular revascularization. Specifically, it remains unclear which perfusion measures and assessment time points are clinically informative, how wound healing is defined and monitored, which local wound-care interventions have direct outcome evidence, and whether nursing or multidisciplinary components have been formally evaluated rather than inferred from routine practice. This fragmentation limits the development of consistent post-revascularization follow-up pathways and prevents firm conclusions regarding comparative effectiveness. Because the evidence spans heterogeneous study designs, populations, assessment methods, interventions, and outcomes, a scoping review is appropriate to map its extent, characteristics, and remaining gaps.⁷

Accordingly, this scoping review aimed to map and characterize evidence published from 2021 to 2026 concerning post-revascularization perfusion assessment, wound evaluation, and local wound care among adults with PAD following lower-extremity angioplasty, stenting, or other endovascular revascularization. The secondary objectives were to characterize the reported clinical and limb outcomes, identify gaps in post-revascularization wound-care evidence, and distinguish formally evaluated nursing or multidisciplinary care components from evidence-informed implications for future practice and research.

Materials and Methods

Study Design

This scoping review was conducted in accordance with the methodological framework proposed by Arksey and O’Malley,⁸ subsequently refined by Levac et al,⁹ urrent guidance from the Joanna Briggs Institute.¹⁰ A scoping review was selected because the literature concerning perfusion assessment, wound evaluation, and local wound care after lower-extremity endovascular revascularization is heterogeneous in study design, patient population, assessment method, intervention, and reported outcome. This approach enabled systematic mapping of the available evidence and identification of knowledge gaps without restricting the review to a single intervention or outcome.⁷ Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, or PRISMA-ScR.¹¹

Review Questions

The primary review question was: What evidence is available concerning post-procedural perfusion assessment, wound evaluation, and local wound care among adults with peripheral artery disease following lower-extremity angioplasty, stenting, or other endovascular revascularization?

The secondary review questions were:

1. Which methods have been used to assess perfusion following lower-extremity endovascular revascularization?

2. How have wound status, wound-healing progression, and limb outcomes been evaluated and reported?

3. Which local wound-care interventions have been implemented after revascularization, and what outcomes have been reported?

4. Which multidisciplinary or nursing-related care components have been described, and what evidence gaps remain?

Search Strategy

A structured literature search was conducted using four electronic information sources: PubMed/MEDLINE, Scopus, CINAHL via EBSCOhost, and ScienceDirect. The final search was completed in August 2026. CINAHL was included to strengthen coverage of nursing, wound-care, and allied-health literature.

The search strategy combined controlled vocabulary, where available, with free-text terms. Search terms represented three principal concepts: peripheral artery disease, lower-extremity endovascular revascularization, and post-procedural perfusion or wound management. Terms relating to PAD and CLTI were combined with terms describing angioplasty, stenting, and endovascular revascularization. These were subsequently combined with terms for perfusion assessment, wound evaluation, wound healing, local wound care, debridement, dressing, and related follow-up outcomes. Boolean operators, truncation, phrase searching, and database-specific subject headings were adapted to the requirements of each source.

Terms requiring an explicitly multidisciplinary, community-based, or nurse-led context were not applied as mandatory search concepts because doing so could have excluded clinically relevant studies that described these components only in the full text. These contextual elements were instead assessed during eligibility screening. Searches were limited to studies published from January 1, 2021, to the final search date in 2026 and written in English or Indonesian. Complete database-specific search strings, search dates, and retrieved record counts are provided in Supplementary File 1.

Eligibility Criteria

Eligibility criteria were developed using the Population, Concept, and Context framework recommended by JBI.¹²

Population

Studies were eligible when they included adults aged 18 years or older with PAD who underwent lower-extremity balloon angioplasty, stent placement, or another endovascular revascularization procedure. Studies involving mixed treatment populations were eligible when at least 80% of participants underwent endovascular revascularization or when data for the eligible endovascular subgroup were reported separately.

Concept

Eligible studies were required to report at least one of the following components after revascularization: objective perfusion assessment, wound evaluation, wound-healing outcomes, or a local wound-care intervention. Perfusion assessments could include the ankle-brachial index, duplex ultrasound, toe pressure, transcutaneous oxygen pressure, skin perfusion pressure, perfusion angiography, thermography, hyperspectral imaging, positron emission tomography, or another relevant modality. Wound evaluation could include standardized wound classification, wound-area measurement, time to healing, complete wound closure, infection, tissue loss, amputation, or other wound-related outcomes. Local wound care could include debridement, dressings, topical oxygen therapy, biological therapies, offloading, or other interventions directed at the wound.

Context

The relevant context was the period following lower-extremity angioplasty, stenting, or other endovascular revascularization. This included care delivered in vascular clinics, inpatient services, outpatient wound-care settings, rehabilitation services, or community follow-up. Studies describing multidisciplinary surveillance or nursing-related activities were eligible when these components were linked to post-revascularization perfusion or wound management.

Peer-reviewed primary research was eligible, including randomized and nonrandomized trials, prospective or retrospective cohort studies, registries, pilot studies, and service evaluations. Qualitative and mixed-methods studies were also eligible if they reported data relevant to the review questions. Only articles published from 2021 to 2026 in English or Indonesian were considered.

Studies were excluded if they:

1. Included a population without PAD or did not provide separately extractable data for an eligible endovascular subgroup.

2. Focused exclusively on open surgical revascularization without an eligible endovascular subgroup.

3. Examined only procedural technique, device performance, stent design, perioperative complications, or systemic pharmacological therapy without post-procedural perfusion, wound, or local wound-care data.

4. Reported only intraoperative technical measurements without subsequent perfusion, wound-healing, or limb-related follow-up.

5. Were conducted exclusively in palliative care settings.

6. Were systematic reviews, scoping reviews, narrative reviews, clinical guidelines, conference abstracts, case reports, editorials, commentaries, letters, protocols, dissertations, or other non-peer-reviewed publications.

7. Were published outside the specified date or language criteria.

Study Selection

All retrieved references were imported into Mendeley and duplicates were removed before screening. Two reviewers, F.Z.S. and M.A.A., independently screened the titles and abstracts against the predefined eligibility criteria. Records considered potentially relevant by either reviewer proceeded to full-text assessment. The same reviewers independently assessed the retrieved full-text reports.

Reasons for exclusion were recorded at the full-text stage using predefined categories: wrong population, wrong concept or intervention, wrong context, wrong publication type, and ineligible publication date or language. Disagreements at either stage were resolved through discussion and consensus. When consensus could not be reached, a third reviewer, U.R, was consulted. Reports that could not be obtained in full text were recorded as not retrieved and were not included in the eligibility assessment. The complete selection process is presented in the PRISMA-ScR flow diagram in Figure 1.

Figure 1.

PRISMA-ScR flow diagram of the study selection process.

Data Charting

A standardized data-charting form was developed for this review and piloted on a subset of eligible studies before full extraction. Two reviewers, F.Z.S. and M.A.A., independently charted the data. Discrepancies were resolved through discussion, with consultation of U.R. when required.

The extracted information included author, publication year, country, study design, clinical setting, sample size, unit of analysis, participant characteristics, PAD or CLTI classification, type of revascularization, and duration of follow-up. Patient-level and limb-level denominators were recorded separately when studies reported outcomes by treated limb or affected extremity.

Data were also extracted on the timing and modality of perfusion assessment, wound-assessment method, definition of wound healing, local wound-care intervention, and reported clinical outcomes. Outcomes of interest included changes in perfusion measures, wound-area reduction, complete wound healing, time to healing, arterial patency, restenosis, reintervention, major adverse limb events, and amputation. Prognostic factors were charted when they were directly examined in relation to wound or limb outcomes. Multidisciplinary and nursing-related activities were extracted only when they were explicitly described in the original report. For mixed populations, only data from the eligible endovascular subgroup were charted whenever separate data were available.

Evidence Attribution and Synthesis

The extracted evidence was synthesized using descriptive numerical summaries and a structured narrative approach. Study characteristics were summarized according to publication year, country, design, sample size, population, revascularization procedure, and follow-up period. Findings were subsequently organized into the following domains: post-revascularization perfusion assessment, wound evaluation and healing outcomes, local wound-care interventions, other prognostic factors and limb outcomes, and nursing or interdisciplinary care components.

Results were attributed to their original studies, and effect estimates, confidence intervals, P values, and denominators were reported as presented by the study authors. Patient-level and limb-level outcomes were not combined. Findings from studies with mixed treatment populations were reported only for the eligible subgroup or were clearly identified as originating from a predominantly endovascular population.

No meta-analysis was undertaken because the purpose of the review was evidence mapping and because substantial heterogeneity was present in study designs, populations, assessment methods, interventions, outcome definitions, and follow-up periods. No formal risk-of-bias or certainty-of-evidence assessment was performed, consistent with the mapping objective of this scoping review. Consequently, the synthesis was interpreted descriptively and was not used to establish comparative effectiveness or causal relationships. Nursing and multidisciplinary implications were distinguished from directly evaluated interventions to avoid attributing outcomes to care models that were not specifically examined in the included studies.

Result

Literature Search and Selection

The database searches identified 4,503 records: PubMed (n=963), Scopus (n=2,124), ScienceDirect (n=1,300), and CINAHL via EBSCOhost (n=116). After removing 1,208 duplicate records, 3,295 unique records underwent title and abstract screening. Of these, 3,213 records were excluded because they did not meet the population, concept, context, publication-type, or date and language criteria.

Full-text retrieval was sought for 82 reports, of which 19 could not be retrieved. The remaining 63 reports were assessed for eligibility. Forty-nine reports were excluded because of an ineligible population (n=15), ineligible concept or intervention (n=14), ineligible post-revascularization context (n=10), ineligible publication type (n=7), or publication outside the specified date or language limits (n=3). Ultimately, 14 studies met all eligibility criteria and were included in the evidence synthesis. The study-selection process is presented in the PRISMA-ScR flow diagram (Figure 1).

Characteristics of Included Studies

The 14 included studies were published between 2021 and 2026 and represented 12 countries. Italy and Japan each contributed two studies, while Canada, Kazakhstan, Türkiye, Spain, South Korea, the United Kingdom, the United States, Taiwan, Singapore, and the Netherlands each contributed one study. The evidence base comprised one randomized comparative trial, eight prospective observational, registry, service-evaluation, or pilot studies, and five retrospective cohort studies. Sample sizes ranged from 12 to 927 participants. Several studies reported outcomes according to treated limbs or affected extremities rather than individual participants; therefore, patient-level and limb-level denominators are reported separately where applicable. The countries, study designs, samples, populations, endovascular contexts, and follow-up periods of the included studies are summarized in Table 1.

Table 1.

Characteristics of the Fourteen Included Studies

Author(s) and Year	Country	Study Design and Sample	Population	Endovascular Procedure or Context	Follow-Up
Mirshahvalad et al, 2026.13	Canada	Prospective pilot study; n = 12	Patients with CLTI, Rutherford category ≥4	Technically successful lower-extremity angioplasty	Clinical follow-up for up to 4 years
Chinaliyev et al, 2025.14	Kazakhstan	Randomized comparative trial; n = 116, 58 per group	Patients with chronic PAD-related lower-extremity ulcers	Successful endovascular intervention before wound-treatment allocation	12 months
Guler et al, 2025.15	Türkiye	Single-center retrospective cohort; 168 patients and 185 affected extremities	Fontaine stage IV CLTI	Successful percutaneous EVT	Median 42 weeks, IQR 23-73
Álvaro-Afonso et al, 2024.16	Spain	Multicenter prospective observational study; n = 28	Patients with ischemic or neuroischemic DFUs	Lower-extremity endovascular revascularization	≥6 months
Nam et al, 2024.17	South Korea	Single-center retrospective study; n = 68; PTA subgroup n = 39	Patients with DFU and PAD	PTA, with stent placement or further dilatation when clinically indicated	28 days
Pitocco et al, 2024.18	Italy	Prospective observational pilot study; n = 35	Patients with type 2 diabetes, CLTI, and diabetic foot vasculopathy	Lower-limb PTA	6 weeks
Rodway et al, 2024.19	United Kingdom	Prospective single-center service evaluation; n = 246; paired measurements available for 219	Symptomatic PAD; CLTI subgroup n = 199	Lower-extremity endovascular revascularization	12 months
Shih et al, 2024.20	United States	Single-center retrospective cohort; n = 257	Symptomatic femoropopliteal disease; 72% presented with CLTI	SFA stenting followed by surveillance and reintervention when indicated	First 2 years of surveillance with longer-term outcome follow-up
Sun et al, 2024.21	Taiwan	Prospective cohort; n = 100	Patients with DFUs undergoing perfusion evaluation	Vascular reconstruction in 51 patients, including PTA in 46 and bypass in 5	Assessments through 6 months; clinical outcomes at 12 months
Tang et al, 2024.22	Singapore	Longitudinal, single-arm, prospective registry; n = 20	Chronic DFUs or poorly healing minor-amputation wounds	Angioplasty for CLTI in 18 of 20 participants	12 weeks
Kleiss et al, 2023.23	The Netherlands	Single-center prospective cohort; 23 patients and 29 treated limbs	PAD, Rutherford categories 2-6	Lower-extremity EVT	6 weeks
Troisi et al, 2023.24	Italy	Prospective pilot cohort; n = 24	Multilevel CLTI with foot wounds	Isolated femoropopliteal endovascular revascularization	6 months
Hata et al, 2021.25	Japan	Multicenter retrospective cohort; n = 927	CLTI with femoropopliteal lesions	DCB angioplasty, n = 138, versus non-DCB endovascular treatment, n = 789	12 months
Mine et al, 2021.26	Japan	Single-center retrospective nonrandomized study; n = 120	CLTI with infrapopliteal lesions	Infrapopliteal EVT	12 months

Note: Sample denominators are reported as patients, limbs, or extremities according to the original studies. Studies containing mixed revascularization populations were retained only when the endovascular subgroup was separately reported or represented the predefined eligible proportion. Post-revascularization assessments, interventions, evaluated outcomes, and main findings are presented separately in Table 2.

Abbreviations: CLTI, chronic limb-threatening ischemia; DCB, drug-coated balloon; DFU, diabetic foot ulcer; EVT, endovascular therapy; IQR, interquartile range; PAD, peripheral artery disease; PTA, percutaneous transluminal angioplasty; SFA, superficial femoral artery.

The included populations predominantly comprised patients with peripheral artery disease, chronic limb-threatening ischemia, diabetic foot ulcers, or chronic ischemic wounds following lower-extremity revascularization. Eleven studies exclusively examined patients treated using endovascular procedures. The remaining three studies included broader revascularization populations but provided an eligible endovascular subgroup or involved cohorts treated predominantly using endovascular procedures. Specifically, 18 of the 20 participants in Tang et al,²² underwent angioplasty, Nam et al,¹⁷ reported findings for a revascularization subgroup of 39 patients, and 46 of the 51 patients in the vascular reconstruction group reported by Sun et al,²¹ underwent percutaneous transluminal angioplasty. Considerable heterogeneity was observed in perfusion measurements, wound definitions, interventions, outcomes, and follow-up periods. Although several studies described wound monitoring and multidisciplinary care activities, none directly evaluated the effectiveness of a formally structured nurse-led post-revascularization pathway. Consequently, the nursing implications identified in this review should be interpreted as evidence-informed applications rather than direct evidence of nurse-led pathway effectiveness. The post-revascularization assessments, interventions, evaluated outcomes, and principal findings are summarized in Table 2.

Table 2.

Post-Revascularization Assessments, Interventions, Outcomes, and Main Findings

Author(s) and Year	Assessment or Intervention	Outcomes Evaluated	Main Findings
Mirshahvalad et al, 2026.13	Dynamic and static [18F]FAZA PET/MR and ABI, performed before and after angioplasty	Long-term clinical response, treatment failure, and changes in PET/MR and ABI parameters	Seven patients had a sustained response and five experienced treatment failure. ΔVT differed between groups (P = 0.003), whereas ΔABI did not (P = 0.329).
Chinaliyev et al, 2025.14	WIfI and Rutherford classifications; allogeneic fibroblasts versus conventional surgical debridement	Initial wound-healing time and complete healing time	Allogeneic fibroblasts were associated with shorter initial healing time (2.59 vs 3.56 months) and complete healing time (5.04 vs 5.80 months; both P < 0.001).
Guler et al, 2025.15	WIfI grades, ABI, DUS, complete epithelialization, and inflammatory indices, including SIRI	Wound healing, predictive performance of inflammatory indices, and major amputation	Healing occurred in 142 of 185 extremities (76.8%). SIRI had the strongest discrimination for healing (AUC 0.840; 95% CI 0.777–0.904). Major amputation occurred in 12 of 43 nonhealing extremities and none of 142 healing extremities.
Álvaro-Afonso et al, 2024.16	AP, TP, ABPI, TBPI, TcPO2, and SPP; dressings, offloading, antibiotics, and infection management	Complete DFU healing and predictive performance of noninvasive perfusion tests	Twenty of 28 DFUs healed (71.4%). TcPO2 and TP showed the best discrimination for healing at cutoffs of 24 and 46 mmHg, respectively. Their combination produced a sensitivity of 0.95.
Nam et al, 2024.17	Angiosome-based TcPO2, FLIR thermography, ABI, and clinical photography at baseline and postoperative days 1, 7, 14, 21, and 28	Changes in tissue oxygenation, foot temperature, and lower-limb perfusion	In more severely impaired angiosomes, TcPO2 increased from 12.5 ± 1.7 to 19.1 ± 2.2 mmHg (P = 0.011), while FLIR temperature increased from 28.8 ± 1.8°C to 32.6 ± 1.6°C (P = 0.018).
Pitocco et al, 2024.18	TcPO2, VWF antigen and activity, and ADAMTS-13 activity before and after PTA	Relationships between tissue oxygenation, VWF activity, and ADAMTS-13 activity	Post-PTA TcPO2 was inversely correlated with VWF activity (r = −0.35; P = 0.04). No direct wound-healing endpoint was reported.
Rodway et al, 2024.19	Ultrasound-derived eABPI and DUS before and within 1 month after revascularization	Wound healing and major adverse limb events	Postprocedural eABPI ≥0.9 was associated with greater wound healing (adjusted HR 2.10; 95% CI 1.30–3.10) and fewer major adverse limb events (adjusted HR 0.28; 95% CI 0.11–0.74).
Shih et al, 2024.20	Routine DUS surveillance for ISR, symptom assessment, and reintervention when indicated	Amputation, ISR detection, and outcomes following reintervention	At least two DUS surveillance visits within 2 years were associated with lower odds of amputation (OR 0.47; 95% CI 0.21–0.98). In symptomatic ISR, 2-year freedom from amputation was 82.0% with reintervention versus 47.7% without reintervention.
Sun et al, 2024.21	Serial TcPO2 and ABI; wound dressings, antibiotics, NPWT, and debridement	Changes in perfusion, amputation, and associations with ESRD	In the predominantly PTA-treated reconstruction group, median TcPO2 increased from 15 to 49 mmHg after treatment and subsequently decreased to 44 and 38 mmHg at 3 and 6 months. Lower or declining TcPO2 was observed more frequently in patients with ESRD and those who underwent amputation.
Tang et al, 2024.22	Topical oxygen therapy with debridement, alginate or silver dressings, and serial wound photography	Wound-area reduction, proportion achieving >75% closure, complete closure, and pain	Fourteen of 20 patients (70.0%) achieved >75% wound closure. Mean wound-area reduction was 91.3% ± 14.9% (P = 0.001), and mean time to complete closure was 77.6 ± 32.5 days.
Kleiss et al, 2023.23	Hyperspectral imaging-derived perfusion measures and thermal imaging immediately before and after EVT	Clinical improvement at 6 weeks and discrimination by imaging-derived changes	Changes in deoxyhemoglobin at the calf and foot differed between limbs with and without clinical improvement (P = 0.027 and P = 0.017), with AUCs of 0.779 and 0.792, respectively. Thermal imaging was not discriminative.
Troisi et al, 2023.24	Two-dimensional perfusion angiography and TcPO2	Changes in perfusion, correlation between assessment methods, and complete wound healing	Mean perfusion time-density curves increased by 212.2%, and TcPO2 increased by 116.4%. The changes were not significantly correlated (r = −0.24; P = 0.30). Complete healing occurred in 15 of 24 patients (62.5%).
Hata et al, 2021.25	DCB versus non-DCB endovascular treatment; ABI, SPP, WIfI, DUS, wound epithelialization, patency, and cdTLR	Wound healing, primary patency, cdTLR, limb salvage, and survival	After propensity-score matching, wound healing was comparable between the DCB and non-DCB groups (74.4% vs 71.9%; P = 0.93). DCB treatment was associated with better primary patency and freedom from cdTLR, but not with improved limb salvage or survival.
Mine et al, 2021.26	Baseline Controlling Nutritional Status (CONUT) score and serial assessment of wound epithelialization	Time to complete wound healing, 12-month wound-healing rate, amputation-free survival, and major adverse limb events	Mean healing time was longer in the higher-CONUT group than in the lower-CONUT group (204 ± 143 vs 124 ± 102 days). The higher-CONUT group had lower 12-month wound-healing (77.3% vs 98.0%) and amputation-free survival rates (69.8% vs 89.5%), as well as a higher incidence of major adverse limb events (46.0% vs 22.8%; P=0.012). A higher CONUT score was independently associated with delayed wound healing (adjusted OR, 11.20; 95% CI, 1.29–97.50; P=0.028).

Note: Findings are reported using the denominators and units of analysis provided by the original studies. Patient-level, limb-level, and extremity-level outcomes were not combined. Associations from observational studies should not be interpreted as evidence of causality. Nursing and multidisciplinary activities were not presented as independently effective interventions unless they were directly evaluated.

Abbreviations: ABI, ankle-brachial index; ABPI, ankle-brachial pressure index; ADAMTS-13, a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13; AP, ankle pressure; AUC, area under the curve; cdTLR, clinically driven target lesion revascularization; CI, confidence interval; CONUT, Controlling Nutritional Status; DCB, drug-coated balloon; DFU, diabetic foot ulcer; DUS, duplex ultrasound; eABPI, ultrasound-estimated ankle-brachial pressure index; ESRD, end-stage renal disease; EVT, endovascular therapy; FLIR, forward-looking infrared; HR, hazard ratio; ISR, in-stent restenosis; NPWT, negative-pressure wound therapy; OR, odds ratio; PET/MR, positron emission tomography/magnetic resonance imaging; PTA, percutaneous transluminal angioplasty; SIRI, systemic inflammation response index; SPP, skin perfusion pressure; TBPI, toe-brachial pressure index; TcPO₂, transcutaneous oxygen pressure; TP, toe pressure; VT, total volume distribution; VWF, von Willebrand factor; WIfI, Wound, Ischemia, and foot Infection.

Post-Revascularization Perfusion Assessment

Post-revascularization perfusion was assessed using the ankle-brachial index (ABI), ultrasound-estimated ankle-brachial pressure index (eABPI), duplex ultrasound (DUS), toe pressure, transcutaneous oxygen pressure (TcPO₂), and skin perfusion pressure. In a prospective evaluation of 199 patients with chronic limb-threatening ischemia, a postprocedural eABPI of ≥0.9 was associated with a higher likelihood of wound healing (adjusted hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.3 to 3.1) and a lower incidence of major adverse limb events (adjusted HR, 0.28; 95% CI, 0.11 to 0.74). Wound healing occurred in 94% of patients with an eABPI of ≥0.9 compared with 67% of those with an eABPI of <0.9 (P=0.0046).¹⁹ DUS was primarily used for vascular surveillance following superficial femoral artery stenting. At least two DUS surveillance visits during the first 2 years were associated with lower odds of amputation (odds ratio [OR], 0.47; 95% CI, 0.21 to 0.98). Among patients with symptomatic in-stent restenosis, the 2-year freedom from amputation was 82.0% among those who underwent reintervention compared with 47.7% among those who did not (P=0.003).²⁰

TcPO₂ was the most frequently investigated measure of tissue-level perfusion. Among 28 patients with ischemic or neuroischemic diabetic foot ulcers, TcPO₂ and toe pressure demonstrated the highest sensitivities for predicting wound healing, at 0.89 and 0.70 using cutoff values of 24 and 46 mmHg, respectively. Combining TcPO₂ and toe pressure increased the sensitivity to 0.95, and TcPO₂ remained independently associated with healing at 6 months (P=0.042) (Álvaro-Afonso et al, 2024). Nam et al,¹⁷ found that mean TcPO₂ in severely impaired angiosomes increased from 12.5 ± 1.7 to 19.1 ± 2.2 mmHg following successful revascularization (P=0.011), while foot temperature measured using forward-looking infrared thermography increased from 28.8 ± 1.8°C to 32.6 ± 1.6°C (P=0.018). In the vascular reconstruction cohort reported by Sun et al,²¹ median TcPO₂ increased from 15 mmHg at baseline to 49 mmHg after treatment and subsequently decreased to 44 and 38 mmHg at 3 and 6 months, respectively. Lower or declining TcPO₂ values were observed more frequently among patients with end-stage renal disease and those who subsequently underwent amputation.

Emerging perfusion assessments included hyperspectral imaging, two-dimensional perfusion angiography, fluorine-18 fluoroazomycin arabinoside ([¹⁸F]FAZA) PET/MR, and perfusion-related biomarkers. Changes in hyperspectral imaging-derived deoxyhemoglobin at the calf and foot discriminated between limbs with and without clinical improvement at 6 weeks, with areas under the curve of 0.779 and 0.792, respectively, whereas thermal imaging did not demonstrate comparable discriminatory performance.²³ Troisi et al,²⁴ reported mean increases of 212.2% in perfusion angiography time-density curves and 116.4% in TcPO₂ following revascularization; however, these changes were not significantly correlated (r=−0.24; P=0.30). In a prospective pilot study of 12 patients, changes in [¹⁸F]FAZA PET/MR-derived total volume distribution differed significantly between patients with a sustained clinical response and those with treatment failure (P=0.003), whereas changes in ABI did not differ significantly between the groups (P=0.329).¹³ Pitocco et al,¹⁸ also identified an inverse correlation between postangioplasty TcPO₂ and von Willebrand factor activity (r=−0.35; P=0.04), although the study did not report a direct wound-healing endpoint. Collectively, these findings demonstrate substantial variation in the techniques used to assess macrovascular patency and tissue-level perfusion after revascularization.

Wound Evaluation and Healing Outcomes

Wound-evaluation methods varied across the included studies. The Wound, Ischemia, and foot Infection (WIfI) classification was used to characterize wound severity and amputation risk.^14,15,25 Other methods included the University of Texas and Rutherford classifications, serial measurement of wound area, standardized wound photography, and clinical assessment of epithelialization. Complete healing was commonly defined as complete epithelialization, generally without major amputation. However, definitions of healing, assessment intervals, analytical denominators, and follow-up periods were not consistent across studies.

Guler et al,¹⁵ evaluated 185 affected extremities in 168 patients with Fontaine stage IV chronic limb-threatening ischemia following successful endovascular treatment. Complete healing occurred in 142 extremities (76.8%), while 43 remained unhealed. Major amputation occurred in 12 of the 43 nonhealing extremities (27.9%) and in none of the 142 healing extremities (P<0.001). Among the evaluated inflammatory indices, the systemic inflammation response index demonstrated the strongest discrimination for wound healing, with an area under the curve of 0.840 (95% CI, 0.777 to 0.904). Nutritional status was also associated with healing outcomes. Mine et al,²⁶ reported a longer mean healing time in patients with a higher Controlling Nutritional Status (CONUT) score than in those with a lower score (204 ± 143 vs 124 ± 102 days). The corresponding 12-month wound-healing rates were 77.3% and 98.0%, respectively. A higher CONUT score was independently associated with delayed wound healing (adjusted OR, 11.20; 95% CI, 1.29 to 97.5; P=0.028).

Healing outcomes varied according to the study population and treatment context. Among 28 patients with ischemic or neuroischemic diabetic foot ulcers, 20 wounds healed within 6 months (71.4%), four patients underwent major amputation (14.3%), and one patient died (3.5%).¹⁶ Troisi et al,²⁴ reported complete healing in 15 of 24 patients (62.5%) at 6 months following isolated femoropopliteal endovascular revascularization. In a multicenter retrospective study of 927 patients, Hata et al,²⁵ found no significant difference in the 1-year cumulative incidence of wound healing between drug-coated and non-drug-coated balloon treatment after propensity-score matching (74.4% vs 71.9%; P=0.93). Drug-coated balloon treatment was associated with higher primary patency (P=0.002) and greater freedom from clinically driven target-lesion revascularization (P=0.010), but no significant differences were observed in limb salvage (P=0.21) or overall survival (P=0.93).

Local Wound-Care Interventions After Revascularization

Only two studies evaluated a defined adjunctive local wound-care treatment as the principal intervention following endovascular revascularization. Chinaliyev et al,¹⁴ randomly assigned 116 patients with chronic peripheral artery disease-related ulcers following successful endovascular intervention to receive either allogeneic fibroblast therapy or conventional surgical debridement. The mean time to initial healing was shorter in the allogeneic fibroblast group than in the conventional debridement group (2.59 ± 0.53 vs 3.56 ± 0.44 months), as was the mean time to complete healing (5.04 ± 0.58 vs 5.80 ± 0.35 months; both P<0.001). However, subgroup analyses were not reported to determine whether the treatment effect varied according to wound severity, ulcer location, diabetes status, or the type of endovascular procedure.

Tang et al,²² evaluated 12 weeks of topical oxygen therapy combined with standard local wound care, including regular debridement and alginate and silver dressings, in 20 patients with chronic diabetic foot ulcers or poorly healing minor-amputation wounds. Eighteen participants (90%) had previously undergone angioplasty for chronic limb-threatening ischemia. Fourteen participants (70%) achieved more than 75% wound closure, and the mean reduction in wound area at 3 months was 91.3% ± 14.9% (P=0.001). Among wounds achieving complete closure, the mean time to closure was 77.6 ± 32.5 days. Because this study was a small, single-arm prospective registry without a concurrent control group, the observed improvements could not be attributed exclusively to topical oxygen therapy.

Other studies reported local wound care as part of routine multidisciplinary management rather than as an independently evaluated intervention. The reported components included dry or moist dressings, surgical or bedside debridement, pressure offloading, antibiotic therapy, infection surveillance, negative-pressure wound therapy, standardized wound photography, and scheduled wound-clinic follow-up.^16,21,22,25 However, the independent contributions of these components to wound healing, limb salvage, and reintervention outcomes could not be determined. None of the included studies directly compared standardized dressing protocols or evaluated a formally structured nurse-led local wound-care pathway after revascularization.

Other Prognostic Factors and Limb Outcomes

Evidence regarding smoking and other prognostic factors was limited and not directly comparable across the included studies. Shih et al,²⁰ reported that active smoking was associated with loss of stent patency (HR, 1.72; 95% CI, 1.00 to 2.98; P=0.050) and major amputation (HR, 3.55; 95% CI, 1.53 to 8.25; P=0.003). Diabetes (HR, 2.61; 95% CI, 1.21 to 6.01; P=0.019), stent occlusion (HR, 17.0; 95% CI, 5.93 to 63.1; P<0.001), and presentation with chronic limb-threatening ischemia (HR, 4.31; 95% CI, 1.86 to 11.7; P=0.002) were also associated with poorer limb-salvage outcomes. Conversely, postprocedural dual antiplatelet therapy was associated with improved limb salvage (HR, 0.23; 95% CI, 0.09 to 0.58; P=0.001). In the study by,¹⁵ smoking was more frequent among patients with nonhealing extremities than among those with healed extremities, although the difference did not reach statistical significance (67.4% vs 49.3%; P=0.054). Thus, smoking was associated with vascular patency and amputation outcomes in one cohort but was not a statistically significant discriminator of wound healing in another.

Reported clinical outcomes extended beyond technical patency and included complete wound closure, time to healing, restenosis, clinically driven target-lesion revascularization, major adverse limb events, major amputation, limb salvage, and survival. However, the outcome definitions, analytical denominators, and follow-up periods differed substantially across studies. Some studies analyzed individual participants, whereas others analyzed treated limbs or affected extremities. Wound healing was variously defined as complete epithelialization, percentage reduction in wound area, or healing without death or major amputation. Because of this clinical and methodological heterogeneity, the findings were synthesized descriptively, and a pooled effect estimate was not calculated.

Nursing and Interdisciplinary Care Components

Several included studies described clinical activities relevant to nursing and interdisciplinary post-revascularization care, including serial wound measurement, standardized wound photography, dressing changes, debridement, pressure offloading, infection surveillance, antibiotic administration, negative-pressure wound therapy, perfusion monitoring, and scheduled wound-clinic follow-up.^{16,17,21,22,25} These activities were generally reported as components of routine multidisciplinary care delivered alongside vascular assessment and medical or surgical management. However, the studies rarely identified the professionals responsible for individual care activities, described the frequency or standardization of their delivery, or quantified their independent contributions to wound healing and limb outcomes.

None of the 14 included studies directly evaluated a structured nurse-led post-revascularization pathway, compared alternative nursing surveillance protocols, or reported predefined nursing-sensitive outcomes. Structured discharge education, home-based wound surveillance, adherence support, nurse-led electronic monitoring, and nurse-coordinated escalation of care were also not formally evaluated. Therefore, the available evidence identifies activities that may inform nursing and interdisciplinary practice but does not establish the effectiveness of a specific nurse-led or integrated multidisciplinary care model following lower-extremity endovascular revascularization. Any implications for nursing practice should consequently be interpreted as evidence-informed and hypothesis-generating rather than as direct evidence of clinical effectiveness.

Discussion

Interpretation of Principal Findings

This scoping review yielded three principal findings. First, the evidence was concentrated on post-revascularization perfusion assessment and wound-healing outcomes, while comparative evidence concerning local wound-care interventions remained limited. Second, technical restoration of arterial patency did not consistently correspond with adequate tissue perfusion or wound closure. Third, although several studies reported activities relevant to nursing and multidisciplinary care, none directly evaluated a structured nurse-led post-revascularization pathway. Collectively, these findings support continued assessment of perfusion, wound progression, and local treatment response after lower-extremity endovascular revascularization. However, they do not establish the superiority of any specific surveillance or care pathway.

The distinction between technical and clinical success was evident across several studies. Hata et al,²⁵ found that drug-coated balloon treatment was associated with improved primary patency and freedom from clinically driven target-lesion revascularization but not with superior wound healing, limb salvage, or survival. Similarly, Guler et al,¹⁵ reported that almost one-quarter of affected extremities remained unhealed despite technically successful endovascular treatment, with major amputations occurring only among nonhealing extremities. These findings suggest that restoration of macrovascular blood flow may be insufficient when microcirculatory impairment, infection, systemic inflammation, nutritional impairment, or extensive tissue loss persists.

Objective perfusion reassessment provided potentially useful prognostic information. A postprocedural eABPI of ≥0.9 was associated with improved wound healing and fewer major adverse limb events, while DUS surveillance and reintervention for in-stent restenosis were associated with improved limb outcomes.^19,20 TcPO₂ and toe pressure were also associated with wound healing, and serial TcPO₂ measurement identified temporal changes following revascularization and less favorable trajectories among patients with end-stage renal disease or subsequent amputation.^16,17,21 These findings are consistent with contemporary PAD and CLTI guidelines that recommend complementary physiological assessment, particularly when ABI interpretation is limited by arterial calcification.^2,3 Nevertheless, the identified eABPI threshold originated from a single-center service evaluation, while the DUS surveillance findings were based on retrospective data. Variation in measurement timing, anatomical location, cutoff values, and healing definitions further limits the direct comparability and generalizability of these findings.

Emerging approaches, including hyperspectral imaging, two-dimensional perfusion angiography, [¹⁸F]FAZA PET/MR, and perfusion-related biomarkers, may provide additional information regarding tissue-level responses after revascularization.^13,18,23,24 However, these approaches were examined predominantly in small, single-center, pilot, or exploratory studies. Their reproducibility, feasibility, cost-effectiveness, and incremental clinical value over established physiological and bedside assessments remain uncertain. Therefore, these technologies should currently be considered investigational or complementary rather than replacements for standard vascular and wound assessment.

Evidence Gaps in Nursing and Multidisciplinary Care

Several included studies reported activities relevant to nursing and multidisciplinary post-revascularization care, including serial wound measurement, standardized photography, dressing changes, debridement, pressure offloading, infection surveillance, antibiotic administration, negative-pressure wound therapy, perfusion monitoring, and scheduled wound-clinic follow-up.^{16,17,22,25,27} However, these activities were generally described as components of routine care rather than as predefined interventions. The studies rarely specified the professional responsible for each activity, the frequency and standardization of care delivery, adherence to care protocols, or the criteria used to escalate treatment.

None of the 14 included studies directly evaluated a structured nurse-led post-revascularization pathway, compared alternative nursing surveillance protocols, or reported predefined nursing-sensitive outcomes. Structured discharge education, home-based wound surveillance, adherence support, electronic monitoring, and nurse-coordinated escalation of care were also not formally evaluated. Consequently, the available evidence does not establish whether nurse-led surveillance or coordination improves wound healing, limb salvage, treatment adherence, quality of life, or healthcare utilization.

Evidence concerning integrated multidisciplinary pathways was similarly limited. Only two studies evaluated a defined adjunctive local wound-care intervention, while other studies reported wound-care components without determining their independent or combined effects.^14,22 Therefore, objective perfusion reassessment, standardized wound assessment, infection surveillance, local wound management, patient education, and coordinated referral should be regarded as evidence-informed components for future pathway development rather than as a proven model of care. Comparative prospective research is required before the effectiveness of a specific nurse-led or multidisciplinary post-revascularization pathway can be established.

Research Gaps and Future Directions

Future research should prioritize standardized comparisons of perfusion-assessment modalities, assessment timing, wound-healing definitions, and local wound-care interventions after lower-extremity endovascular revascularization. Prospective studies may also evaluate clearly defined nursing or multidisciplinary care pathways, but these pathways should be treated as predefined interventions rather than assumed components of routine care. Studies evaluating care-delivery models should specify professional responsibilities, surveillance intervals, escalation criteria, comparators, and core outcomes, including wound closure, time to healing, infection, reintervention, major amputation, functional status, quality of life, and healthcare utilization. Until such evidence becomes available, no specific nurse-led or integrated multidisciplinary pathway should be considered established.

Strengths and Limitations

This scoping review has several strengths. The review followed a predefined methodological framework and was reported in accordance with the PRISMA Extension for Scoping Reviews. The updated search covered four major sources: PubMed, Scopus, ScienceDirect, and CINAHL via EBSCO. This broader coverage strengthened the retrieval of literature relevant to vascular care, wound management, nursing, and multidisciplinary practice. The review also examined the post-revascularization care continuum by integrating objective perfusion assessment, wound evaluation, local wound-care interventions, prognostic factors, and interdisciplinary care considerations. This approach extends the focus beyond technical procedural success and highlights the distinction between restored macrovascular flow and subsequent tissue healing.

Several limitations should nevertheless be considered. Only 14 studies met the eligibility criteria, and most used observational designs. Considerable heterogeneity was identified in patient populations, perfusion measures, wound definitions, interventions, follow-up periods, and reported outcomes. These differences precluded quantitative synthesis and limited direct comparisons across studies. Consistent with the purpose of a scoping review, the evidence was mapped and descriptively synthesized. Therefore, no pooled effect estimates or definitive comparative conclusions regarding the effectiveness of individual assessment methods or wound-care interventions can be made. Furthermore, the absence of a formal risk-of-bias assessment limits conclusions concerning the methodological quality and certainty of the available evidence.

The restriction to studies published from 2021 to 2026 and in English or Indonesian may have excluded relevant earlier studies and publications in other languages. The database-based search may also have missed unpublished or grey literature, potentially introducing publication bias. In addition, most included studies were conducted in well-resourced healthcare settings, while evidence from low- and middle-income countries was limited. Consequently, the applicability of advanced perfusion technologies and multidisciplinary care models to resource-constrained settings, including Indonesia, remains uncertain. Finally, none of the included studies directly evaluated a structured nurse-led post-revascularization pathway. The proposed nursing and interdisciplinary implications should therefore be interpreted as evidence-informed priorities for future research rather than as established effects of a validated care model.

Conclusion

This scoping review indicates that technical success after lower-extremity endovascular revascularization should be distinguished from subsequent tissue perfusion and wound recovery. The available literature primarily describes objective perfusion reassessment and serial wound evaluation, while comparative evidence for local wound-care interventions remains limited. None of the included studies directly evaluated a structured nurse-led or integrated multidisciplinary post-revascularization pathway; therefore, the effectiveness of these care models cannot be determined from the current evidence. Future prospective studies should evaluate clearly defined assessment, wound-care, and care-delivery pathways using consistent clinical, nursing-sensitive, and patient-centered outcomes.

Declaration of Generative AI

Google Gemini 3.1 Pro was used solely to translate selected manuscript text from Indonesian into English. The authors confirm the originality and accuracy of all manuscript content and take full responsibility for the integrity of the whole content, including the accuracy of references. The authors have checked the terms of use for the specific AI tool used and therefore confirm its suitability for publication.

Data Sharing Statement

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Ethics Statement

Ethical approval and informed consent were not required for this study, as it constitutes a systematic review of previously published and publicly available literature. This research did not involve any direct interaction with human participants or animal subjects. All synthesized data were extracted from peer-reviewed publications, and the study was conducted in accordance with standard ethical guidelines for secondary research.

Disclosure

The authors report no conflicts of interest in this work.