One Bout of Calf Raises Induces Improvement of Mitochondrial Function in Claudicants

Abstract

Introduction: The usefulness of angiosome guided therapy in critical limb ischemia has been under debating. We tried to evaluate the efficacy of angiosome guide revascularization comparing the results between complete revascularization using great saphenous vein (GSV) Y graft and single graft bypass. Methods: From Jul 2008 to Dec 2012. a total of 102 CLI patients underwent BTK or pedal bypass surgery for critical limb ischemia. 71 pts (83 limbs) underwent single graft bypass (Anterior tibial artery or posterior tibial artery), otherwise 31 patients (37 limbs) underwent complete revascularization using GSV Y graft. Results: There is no statistical difference between both two groups in terms of preoperative demographics, postoperative complications and mean 3 years follow up results. However, in the patients who underwent single graft bypass surgery, primary patency is longer in positive pedal arc group compared to no pedal arch group (85% in positive pedal arc group vs. 47.6% in no pedal arc group). In the patients who underwent Y graft bypass surgery, primary patency was similar in both groups (87.5% in positive arc group vs. 80% in no pedal arc group). Conclusion: Angiosome guided treatment is necessary in the cases of negative pedal arch. If the patients shows negative compatibility in terms of wound location with angiosome area, and poor pedal arch, complete revascularization using GSV Y graft or angiosome guided single bypass surgery is reasonable. Otherwise, if pedal arch is competent in peri-operative evaluation, single bypass surgery regardless of angiosome is sufficient.