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Donghua Ji MD
The interventional therapy Department of the 1st Hospital of
Dalian Medical University, China
DP, dorsalis pedis artery angiosome; LP, lateral plantar artery angiosome; MP, medial plantar artery angiosome; LC, lateral calcaneal artery angiosome;MC, medial calcaneal artery angiosome
Angiosomes
foot
Angiosome-guided angioplasty
DR vs IR:limb salvage at 4yrs--86% vs 69% Iida o,Nanto S,Uematsu M,et al. Importance of the angiosome concept for endovascular therapy in
patients with critical limb ischemia.Catheter Cardiovasc Interv,2010,75(6):830-836.
DR vs IR:healing rate at 2yrs--91% vs 62% Neville RF,Attinger CE, Bulan EJ,et al. Revascularization of a specific angiosome for limb salvage:
does the target artery matter? Ann Vasc Surg,2009,23(3):367-373.
DR vs IR: healing rate at 1yr--92% vs 73% Alexanderscu V,Vincent G,Azdad K,et al. A reliable approach to diabetic neuroischemic foot wounds:
below-the-knee angiosome-oriented angioplasty.J Endovasc Ther,2011,18(3):376-387.
DR: Direct revascularization
IR: Indirect revascularization
Materials
• A retrospective analysis of 102 infrapopliteal
angioplasty cases with Fontaine Ⅳ ischemia
• Male = 60, age = 72 ±11 yrs
• DR (angioplasty based on the angiosome concept) :47
IR ( angioplasty cases not based on the angiosome concept):55
Baseline of clinical characteristics
Risk factors DR(n=47) IR(n=55) P value
>70yrs 39(83%) 43(78.2%) 0.545
DM>10yrs 44(93.6%) 47(85.5%) 0.187
Coronary artery disease 35(74.5%) 40(72.7%) 0.843
Hypertension 36(76.6%) 43(78.2%) 0.849
Chronic kidney disease 4(8.5%) 6(10.9%) 0.686
End-stage renal disease
(haemodialysis)
10(21.3%) 13(23.6%) 0.696
Hyperlipidemia 41(87.2%) 49(89.1%) 0.773
Baseline of lesions
Lesion characteristics DR(n=47) IR(n=55) P value
2-3 vessels runoff involvement 44(93.6%) 51(92.7%) 0.860
occlusion>10cm 41(87.2%) 52(94.5%) 0.197
Pedal or plantar arch occlusion 26(55.3%) 27(49.1%) 0.532
Pedal tissue loss or gangrene 26(55.3%) 34(61.8%) 0.508
Plantar tissue loss or gangrene 21(44.7%) 21(38.2%) 0.508
Materials of EVT
Site of tissue loss Feeding arteries with EVT
Dorsal tissue loss(n=26)
ATA 18
PTA+PPL 5
ATA+PTA 3
Plantar tissue loss(n=21) PTA 21
DR
ATA: anterior tibial artery PTA: posterior tibial artery PPL: pedal and plantar loop
Site of tissue loss Artereis with EVT
Dorsal tissue loss(n=34)
PTA 9
Per A 12
PTA+Per A 13
Plantar tissue loss(n=21) ATA 3
Per A 8
ATA+Per A 10
IR
ATA: anterior tibial artery PTA: posterior tibial artery Per A: peroneal artery
Methods for evaluation
• Comparison of ABI
• Recording the wound healing condition
• Amputation-free survival (AFS) and
freedom from major amputation (MA)
Results
• Mean follow-up: 18±11 monthes
• 3 cases died of cadiovascular events
DR: 1 case
IR: 2 cases
6 monthes 12monthes
DR 85.1%(40/47) 93.5%(44/46)
IR 60%(33/55) 77.4%(41/53)
P value 0.005 0.01
Healing rate
6 monthes 12 monthes
DR 100%(47/47) 93.5%(44/46)
IR 90.1%(50/55) 84.9%(45/53)
P value 0.035 0.078
Limb salvage rate
Conclusions
• Infrapopliteal angioplasty based on angiosome
concept may prove beneficial in terms of better
wound healing of diabetic critical foot ischemia
and subsequent limb salvage.
• Revascularization should not be denied to patients
with indirect perfusion of the ischemic angiosome
as acceptable rates of limb salvage are obtained. *
* Kabra A, Suresh KR, Vivekanand V, et al. Outcomes of angiosome and non-angiosome
targeted revascularisation in critical lower limb ischemia. J Vasc Surg. 2013;57:44-49