Editor's Choice – Direct vs. Indirect Angiosomal Revascularisation of Infrapopliteal Arteries, an Updated Systematic Review and Meta-analysis

Dilaver, Nafi; Twine, Christopher P.; Bosanquet, David C.

doi:10.1016/j.ejvs.2018.07.017

Cited by 36 publications

(24 citation statements)

References 59 publications

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“…The results of meta-analyses suggest that, when feasible, DR of the foot angiosome affected by ischemic tissue lesions may improve wound healing and limb salvage rates compared with IR. [7][8][9][10]12 However, most authors suggest a cautious interpretation because "the quality of evidence on which these conclusions are based on is low," and further studies of better quality are needed to confirm these results.…”

Section: Is It Possible To Pursue An Angiosome-guided Revascularizatimentioning

confidence: 99%

“…4,5 In the last 15 years multiple studies were published supporting the concept that DR, either percutaneous or surgical, leads to improved healing and limb salvage rates in patients with chronic limb-threatening ischemia (CLTI). [6][7][8][9][10][11][12][13] Subsequent to these numerous reports, the new global vascular guidelines (GVGs) introduce the novel concept of target arterial path that is defined as the optimal arterial pathway to restore in-line (pulsatile) flow to the ankle and foot, and it may incorporate either the least diseased or an angiosome preferred path. 14 In line with this concept of reestablishing a direct line of blood flow to the wound, endovascular treatment of CLTI patients has evolved toward extreme approaches, and below-the-ankle interventions are proposed as a new strategy to improve clinical success of revascularization.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Foot Angiosomes: Instructions for Use

Ferraresi

Clerici

Casini

et al. 2020

The International Journal of Lower Extremity Wounds

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In the last 15 years an abundance of literature has demonstrated that angiosome-targeted revascularization, either endovascular or open, can lead to better clinical results in patients with chronic limb-threatening ischemia. According to this literature, the angiosome concept should guide our treatment strategy in every chronic limb-threatening ischemia patient. However, in our daily practice, its application is often difficult or impossible. Most foot wounds spread over multiple angiosomes and, moreover, the value of an angiosome-guided revascularization approach can vary according to vascular anatomy, collateral vessel network, type of revascularization, and wound. The aim of this article is to explore values and limits of the angiosome concept, and to propose some “instructions for use” regarding its application in our daily practice.

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Section: Is It Possible To Pursue An Angiosome-guided Revascularizatimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Foot Angiosomes: Instructions for Use

Ferraresi

Clerici

Casini

et al. 2020

The International Journal of Lower Extremity Wounds

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“…The nal arterial pattern is a result of the union of vascular channels which were initially homogenous capillary plexuses [11]. During embryological development, the most appropriate channels connecting these two plexuses enlarge, while others retract and disappear [13].…”

Section: Discussionmentioning

confidence: 99%

A Study of the Course, Branching Pattern and Dimensions of the Superior and Inferior Glutealarteries

Ch¹,

Durgesh

B³

et al. 2020

ijsr

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Background: There is a lacuna of information regarding the dimensions of the gluteal arteries. Aim: The present study is to present a detailed account of the pattern of blood supply dimensions of the superior and inferior gluteal arteries. Methods: 62 pelvic halves embalmed with a modified Larssen solution Results & Conclusion: Variations were observed in the origin, course, distribution, and dimensions of superior gluteal (6.45%) and inferior gluteal arteries (9.68%) which are significant, considering the importance of management of clinical conditions associated with the gluteal region like gluteal claudication, neuralgia, and harvesting of perforator flaps.

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“…Congruent observations were also provided by Bunte et al, in a parallel review study focusing on AC applications in CLI [86]. A recent and conspicuous review and meta-analysis made by Dilaver et al gathered an impressive 4146 limbs analysis from 22 selected publications on AC/CLTI treatment strategy [87]. The authors document global superior limb salvage and healing rates for DR versus IR however, with no effects on mortality and re-interventions in these patients [87].…”

Section: Current Literature Review Concerning Dr/wtr Strategiesmentioning

confidence: 96%

“…A recent and conspicuous review and meta-analysis made by Dilaver et al gathered an impressive 4146 limbs analysis from 22 selected publications on AC/CLTI treatment strategy [87]. The authors document global superior limb salvage and healing rates for DR versus IR however, with no effects on mortality and re-interventions in these patients [87]. Specific WTR applications in diabetic patients.…”

Section: Current Literature Review Concerning Dr/wtr Strategiesmentioning

confidence: 99%

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

Alexandrescu¹,

Sinatra²,

Maufroy³

2019

WJCD

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Despite a lack of solid evidence in applying the angiosome concept (AC) in current chronic limb threatening ischemia (CLTI) treatment, several encouraging results for improved wound healing and less for limb preservation were reported in various consistency studies. Direct revascularization (DR) following the foot angiosomes distribution (whenever feasible) may afford better clinical results compared to angiosome indifferent, or indirect revascularization (IR), however without clear benefit on survival and for major adverse limb events (MALE). Inside this interrogation, the notable influence of the remnant collaterals, the foot arches, the wound characteristics, and the type of revascularization (bypass versus endovascular) still remain ardent topics. Current evidence suggests that applying DR in daily vascular practice requires practitioners to be committed to every individual hemodynamic variable in a thorough macro-and micro-vascular evaluation of the ischemic foot. It becomes clearer nowadays that not all CLTI foot ulcers hold same ischemic burden and seemingly need specific DR. In the same setting, a novel wound targeted revascularization (WTR) design was proposed assembling wider circulatory targets than genuine DR notion, as used by some authors. Beyond specific angiosomal artery reperfusion, WTR associates the available arches, the large-and medium-sized collaterals, and the arterial-arterial communicants, in an intentional "source artery" and "collateral" topographic foot revascularization. However, up to date, the notion of angiosome wound-guided revascularization (DR and WTR) detains only a reserved level of confirmation. As for DR, the WTR equally needs higher levels of evidence allowed by standardized definition, uniform indications, and pertinent results from multicenter larger prospective analysis, before large application.

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Editor's Choice – Direct vs. Indirect Angiosomal Revascularisation of Infrapopliteal Arteries, an Updated Systematic Review and Meta-analysis

Cited by 36 publications

References 59 publications

Foot Angiosomes: Instructions for Use

Foot Angiosomes: Instructions for Use

A Study of the Course, Branching Pattern and Dimensions of the Superior and Inferior Glutealarteries

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

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