Evaluation of wound healing after angiosome-directed infrapopliteal endovascular angioplasty in critical limb ischemia

Abstract

Background Because of delayed healing duration of variable foot wounds, techniques for identifying methods to expedite wound healing process were needed. Angiosome concept divides the foot into three-dimensional zones of tissue supplied by specific arterial source. Patients and methods This study included 40 patients (40 limbs) who presented with Rutherford class (5 and 6) foot wounds, with infrapopliteal arterial disease, without significant proximal arterial disease with good run-in and run-off tibial segments and patent foot arch and underwent successful primary tibial angioplasty. Patients were recruited from January 2018 till June 2018 and were followed up till 2 years from July 2018 till July 2020 for the effect of angiosome-directed angioplasty on wound healing and limb salvage rates. Results Direct angiosomal arterial flow to the wound zone was accomplished in 27 (67.5%) patients, with better and faster wound healing rate at 1.4 months (SD: 0.41) and high limb salvage rate, compared with indirect nonangiosomal arterial flow, which was accomplished in 13 (32.5%) patients with delayed wound healing rate at 7.8 months (SD: 1.7) and low limb salvage rate. Age, sex, and different comorbitities were statistically insignificant in wound healing rates. Conclusion The study established that direct angiosomal tibial angioplasty had a considerable role in improving foot wound healing rate, with higher limb salvage rate than the indirect nonangiosomal tibial angioplasty. Obtaining direct arterial supply based on the angiosome technique of perfusion to different foot ulcers or post minor toes amputation ulcer (gangrenous toes) seemed to be significant for wound healing rates in patients with critical limb ischemia.