Revascularization of a specific angiosome for limb salvage: does the target artery matter?

Mohamed G Essawy,Moustafa Abdel Kader,Osama Ismail,Osman Aboelcibaa Osman Ismail,Khaled Hendawy,Moustafa Abdel Fatah

doi:10.1186/s43055-019-0106-8

Mohamed G Essawy, Moustafa Abdel Kader + Show 4 more

Open Access

https://doi.org/10.1186/s43055-019-0106-8

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Abstract

BackgroundTo compare clinical outcomes and technical success when direct versus indirect revascularization was achieved after endovascular technique for critical limb ischemia patients with isolated below-the-knee lesions. Fifty patients were included, 34 male and 16 female, their age from 49 to 77 years (mean 63 ±16). All patients were subjected to infra-genicular angioplasty and divided into direct 28 (31 limbs) and indirect groups 22 (24 limbs). Antegrade approach through ipsilateral CFA was used in 48 patients, while retrograde approach through tibiopedal access was used in 2 patients. Diagnostic angiography was done for all cases and duplex ultrasound was used for follow-up.ResultsOne hundred thirty-two lesions were encountered, 46 in the ATA, 43 in PTA, 29 in peroneal artery, and 19 in dorsalis pedis artery. Transluminal approach was done in 47 limbs while subintimal cross was used in 8 limbs. After 1 year follow-up, AFS was 75% in the direct group and 67% in the indirect group. Freedom from MALE was 65% in the direct group and 55% in the indirect group. Freedom from MA was 86% in the direct group and 75% in the indirect group.ConclusionWhen there is a choice of target artery for revascularization, preference should be given to the artery directly feeding the wound’s angiosome.

Highlights

To compare clinical outcomes and technical success when direct versus indirect revascularization was achieved after endovascular technique for critical limb ischemia patients with isolated below-the-knee lesions
There is increasing evidence that treatment of chronic limb ischemia (CLI) patients either by bypass surgery or endovascular therapy (EVT) mostly could provide best results if based on angiosome concept [9, 10], which was introduced by Palmer and Taylor in 1987
There are six angiosomes on the foot according to the regions supplied by the posterior tibial artery (PTA), anterior tibial artery (ATA), and peroneal artery (PeA)

Summary

Introduction

To compare clinical outcomes and technical success when direct versus indirect revascularization was achieved after endovascular technique for critical limb ischemia patients with isolated below-the-knee lesions. Successful revascularization does not ensure freedom from major amputation and wound healing [5, 6]. This failure may be due to inefficient local revascularization as no adequate vascular connections exist between the revascularized artery and the local ischemic area [7], There is increasing evidence that treatment of chronic limb ischemia (CLI) patients either by bypass surgery or EVT mostly could provide best results if based on angiosome concept [9, 10], which was introduced by Palmer and Taylor in 1987. The calcaneal branch of the PeA supplies the plantar heel and lateral ankle while the anterior branch of PeA feeds the anterior upper ankle [12]

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