Is Angiosome-Guided Endovascular Therapy Worthwhile?

Hata, Yutaka; Iida, Osamu; Mano, Toshiaki

doi:10.3400/avd.ra.19-00042

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…13–15 Even though many studies described the efficacy of direct revascularization for wound healing, its utility remains inconclusive. 16 The current study showed that the SPP increased on both the dorsal and plantar surfaces of the foot regardless of whether direct or indirect revascularization was conducted. Similar trends have been reported by previous investigators.…”

Section: Discussionmentioning

confidence: 51%

Changes in Skin Perfusion Pressure After Endovascular Treatment for Chronic Limb-Threatening Ischemia

et al. 2020

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Purpose To assess skin perfusion pressure (SPP) changes after endovascular treatment (EVT) of patients with chronic limb-threatening ischemia (CLTI) and to explore preoperative factors that affect SPP changes. Materials and Methods This prospective, multicenter study recruited 147 patients (mean age 74 years; 99 men) with ischemic wounds at 6 vascular centers in Japan between July 2017 and December 2018. Over half of the patients (92, 63%) were diabetic, and 76 (52%) required dialysis. Sixty-four patients (43%) had WIfI (wound, ischemia, foot infection) wound grades of 2 or 3; 59 (40%) had foot infections. SPP was measured before and 1, 2, 7, and 30 days after EVT to establish inline flow to the ischemic foot based on the angiosome concept when feasible. The anterior and posterior tibial arteries and the peroneal artery were revascularized in 66 (45%), 50 (34%), and 30 (21%) patients, respectively. Results Both the dorsal and plantar SPPs at 1 or 2 days post-EVT were significantly higher than those at baseline (p<0.001), and both SPPs increased further at 1 month compared with those at 1 (p=0.001) or 2 days (p=0.006) post-EVT. SPP increases occurred on the dorsal and plantar surfaces of the foot regardless of the vessel revascularized. The SPP increase at 1 month after EVT was significantly lower in patients with foot infections than that in those without foot infections (p=0.003). Age, sex, diabetes, dialysis, wound severity, and direct revascularization did not affect the pattern of SPP change. Conclusion The SPP increased continuously up to 1 month after EVT, though the increase was smaller in patients with wound infections. The SPP on the dorsal and plantar surfaces increased, regardless of the vessel revascularized, which could justify indirect revascularization when direct revascularization is technically challenging.

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Section: Discussionmentioning

confidence: 51%

Changes in Skin Perfusion Pressure After Endovascular Treatment for Chronic Limb-Threatening Ischemia

et al. 2020

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“…9,11,12 However, other studies have suggested that IR can achieve the same effect as DR in promoting ulcer healing when there is abundant collateral circulation in the affected limb. 13 Patients with PAD complicated with diabetes differed from patients without diabetes in their clinical manifestation and outcomes. 14 PAD with diabetes normally involves more distant vessels (i.e., infrapopliteal arteries).…”

Section: Discussionmentioning

confidence: 99%

Angiosome-Guided Endovascular Revascularization for Treatment of Diabetic Foot Ulcers with Peripheral Artery Disease

Hou

Guo

Cai

et al. 2022

Annals of Vascular Surgery

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“…Among these participants, 407 underwent endovascular revascularization, while 173 had surgical revascularization targeting the infrapopliteal arteries. The findings showed that angiosome-targeted revascularization is important due to endovascular thrombectomy (EVT), particularly in the absence of a complete pedal arch [62]. The study demonstrated that, in addition to elevated C-reactive protein (CRP), rheumatoid arthritis, and the total number of affected angiosomes, a factor that independently predicts poor leg salvage is an incomplete pedal arch identified during pre-surgery angiography [48,62].…”

Section: Endovascular Versus Bypassmentioning

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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Is Angiosome-Guided Endovascular Therapy Worthwhile?

Cited by 9 publications

References 18 publications

Changes in Skin Perfusion Pressure After Endovascular Treatment for Chronic Limb-Threatening Ischemia

Changes in Skin Perfusion Pressure After Endovascular Treatment for Chronic Limb-Threatening Ischemia

Angiosome-Guided Endovascular Revascularization for Treatment of Diabetic Foot Ulcers with Peripheral Artery Disease

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

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