Angiosome-targeted isolated tibial angioplasty for healing of ischemic foot ulcer: a retrospective study

Abstract

Purpose On the basis of the angiosome concept in critical limb ischemia patients who presented with isolated tibial lesions and foot ulcers, we evaluated and compared clinical outcomes, ulcer healing, and amputation-free survival between patients with successful angiosome-targeted tibial angioplasty alone [direct revascularization (DR)], patients with indirect revascularization (IR) in whom the dilated vessels successfully were the nonangiosome target, and those who underwent combined revascularization (CR) (both DR and IR were achieved). Patients and methods We retrospectively analyzed a total of 66 critical limb ischemia patients who presented with ischemic foot ulcer with isolated tibial vessel lesions at Mansura University Hospital during the period from January 2014 to January 2016. DR of the ischemic angiosome was performed in 37.8% (n=25), IR in 33.3% (n=22), and CR in 28.7% (n=19) of patients. All patients were evaluated for the status of wound healing and limb salvage at 1, 3, 6, 9, and 12 months. The study endpoints were major amputation or death, limb salvage, and ulcer epithelialization at 12 months. Results The mean follow-up was 11.08±3.2, ranging from 3 to 13 months. On Kaplan–Meier analysis, 65% of patients were diabetic. Ulcer healing rate at 12-month follow-up based on angiosome hypothesis among groups CR, DR, and IR was 94.7, 66.7, and 57.17%, respectively, with a significant P value (0.013) between CR and DR and a significant P value ( Conclusion If technically feasible, dilation of angiosome target artery plus any other significant tibial artery lesions should be considered. We should orient procedures toward multiple angiosome reopening with better ulcer healing rate and limb salvage. However, with limitations and challenges of angiosome-based strategies, especially in diabetic patients with depletion of choke vessels, we believe that IR should not be denied with acceptable result over the time.