Angiosome Concept in the Endovascular Management of Chronic Atherosclerotic Ischaemia of Lower Extremities in Diabetics

Abstract

Introduction: The role of the angiosome theory in infrapopliteal disease is controversial. We aimed to study the impact of direct angiosomal revascularization on the outcome in the presence and absence of a complete foot arch. Method: We studied consecutive patients presenting with infrapopliteal disease from February 2013 to January 2014, Rutherford categories 5&6, where only one infrapopliteal vessel was successfully revascularized. Patients were classified into the following groups: (i)DF: direct angiosome revascularization with patent foot arch, (ii)DN: direct angiosome revascularization with no foot arch, (iii)IF: indirect angiosome revascularization with patent foot arch, and (iv)IN: indirect angiosome revascularization with no foot arch. The outcome of the four groups was compared using Chi square test and ANOVA tests. Results: 75 patients presented during the study period; 20 DF, 22 DN, 17 IF, & 16 IN. There were no statistical differences in age, sex, risk factors, run off vessel, or site of tissue loss. Limb salvage rates after 12 months were 95% in DF, 91% in DN, 76.5% in IF, and 44% in IN (p=0.0046). Mean number of days till wound healing was 72.2±16.7 in DF, 122.9±20.6 in DN, 229.4±30.3 in IF, and 308.1±29.6 in IN (p<0.001). Conclusion: Group DF showed significantly better results in limb salvage and wound healing, followed by DN, IF, and lastly IN. A complete foot arch had a significant impact on clinical outcome, in addition to direct angiosomal revascularization. Future studies on the angiosome concept should include the completeness of foot arch as an important factor contributing to healing and limb salvage. Keywords: angiosome, infrapopliteal angioplasty, foot arch