Evaluation of the Angiosome Concept Using Near-Infrared Fluorescence Imaging with Indocyanine Green

Tange, Floris; Ferrari, Bien R; Hoven, Pim van den; Schaik, Jan van; Schepers, Abbey; Rijswijk, Catharina S.P. van; Meer, R.W. van der; Putter, Hein; Vahrmeijer, Alexander L.; Hamming, Jaap F.; Vorst, Joost R van der

doi:10.1016/j.avsg.2023.01.006

Cited by 4 publications

(2 citation statements)

References 37 publications

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“…A recent study with 52 patients used ICG-FI before and after revacularization, and they did not find significant difference in perfusion increase between DR and IR angiosomes. 19 In their series, only two were crural revascularizations, and the rest (95%) were aortoiliac and femoropopliteal interventions.…”

Section: Discussionmentioning

confidence: 97%

Perfusion increase in foot angiosomes: Comparison between direct and indirect revascularization of crural arteries

Venermo,

Settembre

2024

Scand J Surg

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Background and aims: In retrospective studies, wound healing and leg salvage have been better if revascularization is targeted to the crural artery supplying arterial flow to the wound angiosome. No data exist on how revascularization changes the blood flow in foot angiosomes. The aim of this study was to evaluate the change in perfusion after infrapopliteal artery revascularization in all foot angiosomes and to compare directly revascularized (DR) angiosomes to the indirectly revascularized (IR) angiosomes. Methods: In this prospective study, foot perfusion was measured with indocyanine green fluorescence imaging (ICG-FI) before and after either surgical or endovascular below-knee revascularization. According to angiograms, we divided the foot angiosomes into DR and IR angiosomes. Furthermore, in a subanalysis, the IR angiosomes were graded as IR_Coll+ angiosomes if there were strong collaterals arising from the artery which was revascularized, and as IR_Coll– angiosomes if strong collaterals were not seen. Results: A total of 72 feet (28 bypass, 44 endovascular revascularizations) and 282 angiosomes were analyzed. Surgical and endovascular revascularization increased perfusion significantly in both DR and IR angiosomes. After bypass surgery, the increase in DR angiosomes was 55 U and 53 U in IR angiosomes; there were no significant difference in the perfusion increase between IR and DR angiosomes. After endovascular revascularization, perfusion increased significantly more, 40 U, in DR angiosomes compared to 26 U in IR angiosomes (p < 0.05). In the subanalysis of IR angiosomes, perfusion increased significantly after surgical bypass regardless of whether strong collaterals were present or not. After endovascular revascularization, however, a significant perfusion increase was noted in the IR_Coll+ but not in the IR_Coll− subgroup. Conclusion: Open revascularization increased perfusion equally in DR and IR angiosomes, whereas endovascular revascularization increased perfusion significantly more in DR than in IR angiosomes. Strong collateral network may help increase perfusion in IR angiosomes.

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Section: Discussionmentioning

confidence: 97%

Perfusion increase in foot angiosomes: Comparison between direct and indirect revascularization of crural arteries

Venermo,

Settembre

2024

Scand J Surg

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“…The Global Vascular Guidelines (GVG) recommend using the term CLTI instead of "critical" or "severe" limb ischemia. This preference arises because the latter terms designate specific hemodynamic thresholds [2,5], thereby overlooking the broader spectrum and interconnection of components beyond ischemia [2, 6,7]. These components play a partial role in the high rate of major amputations and the low rate of long-term survival [2, 5,8,9].…”

Section: Chronic Limb-threatening Ischemiamentioning

confidence: 99%

Angiosome-Targeted Infrapopliteal Angioplasty: Impact on Clinical Outcomes—An Observational Study

Popitiu,

Alexandrescu,

Clerici

et al. 2024

JCM

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Background: Revascularization based on the angiosome concept (AC) is a controversial subject because there is currently no clear evidence of its efficacy, due to the heterogeneity of patients (multiple and diverse risk factors and comorbidities, multiple variations in the affected angiosomes). Choke vessels change the paradigm of the AC, and the presence or absence of the plantar arch directly affects the course of targeted revascularization. The aim of this study was to evaluate the effect of revascularization based on the AC in diabetic patients with chronic limb-threatening ischemia (CLTI). Methods: This retrospective analysis included 51 patients (40 men, 11 women), with a mean age of 69 years (66–72) and a total of 51 limbs, who presented with Rutherford 5–6 CLTI, before and after having undergone a drug-coated balloon angioplasty (8 patients) or plain balloon angioplasty (43). Between November 2018 and November 2019, all patients underwent below-the-knee balloon angioplasties and were followed up for an average of 12 months. The alteration of microcirculation was compared between directly and indirectly revascularized angiosomes. The study assessed clinical findings and patient outcomes, with follow-up investigations, comparing wound healing rates between the different revascularization methods. Patient records and periprocedural leg digital subtraction angiographies (DSA) were analyzed. Differences in outcomes after direct revascularization and indirect percutaneous transluminal angioplasty (PTa) were examined using Cox proportional hazards analysis, with the following endpoints: ulcer healing, limb salvage, and also amputation-free survival. Results: Direct blood flow to the angiosome supplying the ulcer area was achieved in 38 legs, in contrast to 13 legs with indirect revascularization. Among the cases, there were 39 lesions in the anterior tibial artery (ATA), 42 lesions in the posterior tibial artery (PTA), and 8 lesions in the peroneal artery (PA). According to a Cox proportional hazards analysis, having fewer than three (<3) affected angiosomes (HR 0.49, 95% CI 0.19–1.25, p = 0.136) was associated with improved wound healing. Conversely, wound healing outcomes were least favorable after indirect angioplasty (p = 0.206). When adjusting the Cox proportional hazard analysis for the number of affected angiosomes, it was found that direct drug-coated angioplasty resulted in the most favorable wound healing (p = 0.091). At the 1-year follow-up, the major amputation rate was 17.7%, and, according to a Cox proportional hazards analysis, atrial fibrillation (HR 0.85, 95% CI 0.42–1.69, p = 0.637), hemodialysis (HR 1.26, 95% CI 0.39–4.04, p = 0.699), and number of affected angiosomes > 3 (HR 0.94, 95% CI 0.63–1.39, p = 0.748) were significantly associated with poor leg salvage. Additionally, direct endovascular revascularization was associated with a lower rate of major amputation compared to indirect angioplasty (HR 1.09, 95% CI 0.34–3.50, p = 0.884). Conclusions: Observing the angiosomes concept in decision-making appears to result in improved rates of arterial ulcer healing and leg salvage, particularly in targeted drug-coated balloon angioplasty for diabetic critical limb ischemia, where multiple angiosomes are typically affected.

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M2 macrophage-derived exosomes induce angiogenesis and increase skin flap survival through HIF1AN/HIF-1α/VEGFA control

Luo,

Zhou,

Cao

et al. 2024

Archives of Biochemistry and Biophysics

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Evaluation of the Angiosome Concept Using Near-Infrared Fluorescence Imaging with Indocyanine Green

Cited by 4 publications

References 37 publications

Perfusion increase in foot angiosomes: Comparison between direct and indirect revascularization of crural arteries

Perfusion increase in foot angiosomes: Comparison between direct and indirect revascularization of crural arteries

Angiosome-Targeted Infrapopliteal Angioplasty: Impact on Clinical Outcomes—An Observational Study

M2 macrophage-derived exosomes induce angiogenesis and increase skin flap survival through HIF1AN/HIF-1α/VEGFA control

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