Long-Term Outcomes of Direct and Indirect Below-The-Knee Open Revascularization Based on the Angiosome Concept in Diabetic Patients with Critical Limb Ischemia

Lejay, Anne; Georg, Yannick; Tartaglia, Elvira; Gærtner, S.; Gény, Bernard; Thaveau, Fabien; Chakfé, Nabil

doi:10.1016/j.avsg.2013.08.026

Cited by 60 publications

(81 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Evidently, all studies had omitted to distinguish the types of diabetes included and their relative proportions within the cohort. Lejay et al [39] neglected to indicate their diagnostic criterion for diabetes, and three studies [37–39] neither specified the subjects’ duration of disease nor the adequacy of their glycaemic control. In addition, while the minimum reporting requirements for core patient details have been stated by the IWGDF [35] to be age, sex and ethnicity, all studies had omitted to document the ethnicity of their subjects.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The comparative efficacy of angiosome‐directed and indirect revascularisation strategies to aid healing of chronic foot wounds in patients with co‐morbid diabetes mellitus and critical limb ischaemia: a literature review

Khor

Price

2017

Journal of Foot and Ankle Research

View full text Add to dashboard Cite

BackgroundIschaemic ulcerations have been reported to persist and/or deteriorate despite technically successful revascularisations; a higher incidence of which affects patients with diabetes and critical limb ischaemia. In the context of wound healing, it is unclear if applications of the angiosome concept in ‘direct revascularisation’ (DR) would be able to aid the healing of chronic foot ulcerations better than the current ‘best vessel’ or ‘indirect revascularisation’ (IR) strategy in patients with co-morbid diabetes and critical limb ischaemia.MethodsA literature search was conducted in eight electronic databases, namely AMED, CINAHL, The Cochrane Library, ProQuest Health & Medicine Complete, ProQuest Nursing & Allied Health Source, PubMed, ScienceDirect and TRIP database. Articles were initially screened against a pre-established inclusion and exclusion criteria to determine eligibility and subsequently appraised using the Newcastle-Ottawa Scale.ResultsFive retrospective studies of varying methodological quality were eligible for inclusion in this review. Critical analysis of an aggregated population (n = 280) from methodologically stronger studies indicates better wound healing outcomes in subjects who had undergone DR as compared to IR (p < 0.001; p = 0.04). DR also appears to result in a nearly twofold increase in probability of wound healing within 12 months (hazard ratio, 1.97; 95% CI, 1.34–2.90). This suggests that achieving direct arterial perfusion to the site of ulceration may be important for the healing of chronic diabetic foot ulcerations.ConclusionIncorporating an angiosome-directed approach in the lower limb revascularisation strategy could be a very useful adjunct to a solely indirect approach, which could increase the likelihood of wound healing. With the limited data currently available, findings appear promising and merit from further investigation. Additional research to form a solid evidence base for this revised strategy in patients with co-morbid diabetes and critical limb ischaemia is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-017-0206-5) contains supplementary material, which is available to authorized users.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Firstly, three cohorts [37–39] comprised of a consecutive sample of subjects, effectively upholding the impartiality of their data. Having lapsed in this regard, it is difficult to ascertain the neutrality of data in the remaining two studies [36, 40] from selection bias.…”

Section: Discussionmentioning

confidence: 99%

The comparative efficacy of angiosome‐directed and indirect revascularisation strategies to aid healing of chronic foot wounds in patients with co‐morbid diabetes mellitus and critical limb ischaemia: a literature review

Khor

Price

2017

Journal of Foot and Ankle Research

View full text Add to dashboard Cite

show abstract

“…More refined information is now available regarding the ''choke vessels'' 1,2 that connect the foot angiosomes 1,2,4,16 in specific populations, such as diabetic 3,7,8,18,27 or renal 16,24,25 patients with scarce collateral reserve. 7,16 Identification of the importance of the foot arches, 2,14 the large (.0.5 mm) arterial-arterial collaterals, 2,4,16,28 and the key role of metatar-sal perforators 2,8,[15][16][17] has also occurred since wound-oriented vs. blind revascularization was conceived.…”

Section: Direct Vs Indirect Revascularizationmentioning

confidence: 99%

“…16,[27][28][29][30]32 If one takes a closer look specifically at methods, there is a relative lack of consensus as to how the direct/indirect revascularization strategy is explained in the protocol. [2][3][4][5][6][7][8][9][14][15][16][17][18][19][20]32 A majority of authors employ the principal foot angiosome arteries as the standard method in topographical direct revascularization applications. [1][2][3][5][6][7][8]18,29,30 Yet, following the same wound-directed revascularization meaning (often but not always associated with direct revascularization), 16,21 other researchers reveal comparable results, acknowledging either correct foot arches reperfusion, 14 the reconstitution of large below-the-ankle collaterals 2,4 and optimal foot runoff scores, 17 or both.…”

Section: Direct Vs Indirect Revascularizationmentioning

confidence: 99%

“…8,16,30,44 Interestingly, only a few publications regarding the importance of macro-and micro-circulation assessment in CLI are available in the literature 35 and even scarcer are observations about their specific investigation. 16,35 Although macrocirculatory arterial pathways generally respect the 6 foot and ankle angiosomes 1,2 (with 9%-12% described anatomical variations 37,46 ), independent microcirculatory evaluation (particularly in collateral-deprived patients) 8,[16][17][18]31,45 can be crucial while performing direct revascularization (Figs. 1 and 2).…”

Section: Wound-directed Revascularization From a Macro-and Microcircumentioning

confidence: 99%

See 1 more Smart Citation

Commentary: Myths and Proofs of Angiosome Applications in CLI: Where Do We Stand?

Alexandrescu¹

2014

Journal of Endovascular Therapy

View full text Add to dashboard Cite

Effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral artery disease: a systematic review

Hinchliffe

Brownrigg

Andros

et al. 2016

Diabetes Metabolism Res

154

107

View full text Add to dashboard Cite

Symptoms or signs of peripheral artery disease (PAD) can be observed in up to 50% of the patients with a diabetic foot ulcer and is a risk factor for poor healing and amputation. In 2012, a multidisciplinary working group of the International Working Group on the Diabetic Foot published a systematic review on the effectiveness of revascularization of the ulcerated foot in patients with diabetes and PAD. This publication is an update of this review and now includes the results of a systematic search for therapies to revascularize the ulcerated foot in patients with diabetes and PAD from 1980 to June 2014. Only clinically relevant outcomes were assessed. The research conformed to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and Scottish Intercollegiate Guidelines Network methodological scores were assigned. A total of 56 articles were eligible for full-text review. There were no randomized controlled trials, but there were four nonrandomized studies with a control group. The major outcomes following endovascular or open bypass surgery were broadly similar among the studies. Following open surgery, the 1-year limb salvage rates were a median of 85% (interquartile range of 80-90%), and following endovascular revascularization, these rates were 78% (70-89%). At 1-year follow-up, 60% or more of ulcers had healed following revascularization with either open bypass surgery or endovascular techniques. Studies appeared to demonstrate improved rates of limb salvage associated with revascularization compared with the results of conservatively treated patients in the literature. There were insufficient data to recommend one method of revascularization over another. There is a real need for standardized reporting of baseline demographic data, severity of disease and outcome reporting in this group of patients.

show abstract

Long-Term Outcomes of Direct and Indirect Below-The-Knee Open Revascularization Based on the Angiosome Concept in Diabetic Patients with Critical Limb Ischemia

Cited by 60 publications

References 24 publications

The comparative efficacy of angiosome‐directed and indirect revascularisation strategies to aid healing of chronic foot wounds in patients with co‐morbid diabetes mellitus and critical limb ischaemia: a literature review

The comparative efficacy of angiosome‐directed and indirect revascularisation strategies to aid healing of chronic foot wounds in patients with co‐morbid diabetes mellitus and critical limb ischaemia: a literature review

Commentary: Myths and Proofs of Angiosome Applications in CLI: Where Do We Stand?

Effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral artery disease: a systematic review

Contact Info

Product

Resources

About