Below-the-Ankle Angioplasty in Patients with Critical Limb Ischemia: A Systematic Review and Meta-Analysis

Huizing, Eline; Schreve, Michiel A; Vries, Jean‐Paul P.M. de; Ferraresi, Roberto; Kum, Steven; Ünlü, Çağdaş

doi:10.1016/j.jvir.2019.05.001

Cited by 22 publications

(17 citation statements)

References 26 publications

(78 reference statements)

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“…Foot revascularization is still under debate and a there is no common strategy. Although Huizing et al have reported no significant difference in amputation free survival between BTA angioplasty and below-the-knee angioplasty [26], other studies have documented as BTA angioplasty is associated with reduced rate of major amputation [27][28][29] as we have found in our data.…”

Section: Discussioncontrasting

confidence: 61%

Foot Revascularization Avoids Major Amputation in Persons with Diabetes and Ischaemic Foot Ulcers

Meloni

Morosetti

Giurato

et al. 2021

JCM

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The study aims to evaluate the effectiveness of foot revascularization in persons with diabetic foot ulcers (DFUs) and below-the-ankle (BTA) arterial disease. Consecutive patients referred for a new active ischaemic DFU requiring lower limb revascularization were considered. Among those, only patients with a BTA arterial disease were included. Revascularization procedures were retrospectively analysed: in the case of successful foot revascularization (recanalization of pedal artery, or plantar arteries or both) or not, patients were respectively divided in two groups, successful foot perfusion (SFP) and failed foot perfusion (FFP). Healing, minor and major amputation at 12 months of follow-up were evaluated and compared. Eighty patients (80) were included. The mean age was 70.5 ± 10.9 years, 55 (68.7%) were male, 72 (90%) were affected by type 2 diabetes with a mean duration of 22.7 ± 11.3 years. Overall 45 (56.2%) patients healed, 47 (58.7%) had minor amputation and 13 (16.2%) major amputation. Outcomes for SFP and FFP were respectively: healing (89.3 vs. 9.1%, p < 0.0001), minor amputation (44.7 vs. 78.8%, p = 0.0001), major amputation (2.1 vs. 36.3%, p < 0.0001). Failed foot revascularization resulted an independent predictor of non-healing, minor amputation, and major amputation. Foot revascularization is mandatory to achieve healing and avoid major amputation in persons with ischaemic DFU and BTA arterial disease.

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Section: Discussioncontrasting

confidence: 61%

Foot Revascularization Avoids Major Amputation in Persons with Diabetes and Ischaemic Foot Ulcers

Meloni

Morosetti

Giurato

et al. 2021

JCM

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“…14 In line with this concept of reestablishing a direct line of blood flow to the wound, endovascular treatment of CLTI patients has evolved toward extreme approaches, and below-the-ankle interventions are proposed as a new strategy to improve clinical success of revascularization. 15,16 Accordingly, the angiosome concept should guide our treatment strategy in every CLTI patient; however, in our daily practice, its application is often difficult or impossible. First, unambiguous assignment of foot wounds to a single angiosome is possible only in a minority of cases; toe lesions, for example, which represent more than half of the lesions encountered in ischemic diabetic foot, should have a dual blood supply from the dorsalis pedis artery (DPA) and the plantar arch.…”

Section: Introductionmentioning

confidence: 99%

“…In line with this concept of reestablishing a direct line of blood flow to the wound, endovascular treatment of CLTI patients has evolved toward extreme approaches, and below-the-ankle interventions are proposed as a new strategy to improve clinical success of revascularization. 15,16…”

Section: Introductionmentioning

confidence: 99%

Foot Angiosomes: Instructions for Use

Ferraresi

Clerici

Casini

et al. 2020

The International Journal of Lower Extremity Wounds

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In the last 15 years an abundance of literature has demonstrated that angiosome-targeted revascularization, either endovascular or open, can lead to better clinical results in patients with chronic limb-threatening ischemia. According to this literature, the angiosome concept should guide our treatment strategy in every chronic limb-threatening ischemia patient. However, in our daily practice, its application is often difficult or impossible. Most foot wounds spread over multiple angiosomes and, moreover, the value of an angiosome-guided revascularization approach can vary according to vascular anatomy, collateral vessel network, type of revascularization, and wound. The aim of this article is to explore values and limits of the angiosome concept, and to propose some “instructions for use” regarding its application in our daily practice.

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“…Our study showed a favorable patency and limb salvage rate for patients treated with lower limb bypass revascularization if compared to the endovascular results reported in the literature of patients treated for arterial disease extended below the ankle. 31…”

Section: Discussionmentioning

confidence: 99%

Inframalleolar bypass for chronic limb-threatening ischemia

et al. 2021

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The aims of this study were to analyze the results of inframalleolar bypass for chronic limb-threatening ischemia (CLTI) and to identify outcome-predicting factors. All consecutive patients undergoing inframalleolar bypass for CLTI between 2015 and 2018 were included in this retrospective, single-center study. Outflow artery was the most proximal patent vessel segment in continuity with inframalleolar arteries. Bypasses originating from the popliteal artery were defined as ‘short bypasses’. Sixty patients underwent inframalleolar bypass, with four patients undergoing bilateral procedures, making a total of 64 limbs included. The mean age was 73 ± 14 and 52 (81%) were male. The great saphenous vein was the preferred conduit ( n = 58, 91%), in a devalvulated fashion ( n = 56, 88%). Superficial femoral artery was the most common inflow artery for ‘long’ grafts ( n = 22, 34%), while popliteal artery was the inflow artery for all ‘short’ grafts ( n = 25, 39%). Dorsalis pedis artery was chosen as an outflow artery in 41 patients (63%). Median follow-up was 21 months. Two-year primary and secondary patency, limb salvage, amputation-free survival, and overall survival rates were 67 ± 6%, 88 ± 4%, 84 ± 4%, 72 ± 6%, and 85 ± 4%, respectively. At multivariate analysis, dialysis was an independent predictor for poor primary patency (HR, 4.6; 95% CI, 1.62–13.05; p = 0.004), whereas a short bypass was independently associated with an increased primary patency (HR, 0.3; 95% CI, 0.10–0.89; p = 0.03). In conclusion, bypass grafting to the inframalleolar arteries resulted in good patency rates, limb salvage and overall survival. Dialysis patients had lower primary patency but still had good limb salvage and survival. Short bypass was a predictor of improved primary patency.

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Below-the-Ankle Angioplasty in Patients with Critical Limb Ischemia: A Systematic Review and Meta-Analysis

Cited by 22 publications

References 26 publications

Foot Revascularization Avoids Major Amputation in Persons with Diabetes and Ischaemic Foot Ulcers

Foot Revascularization Avoids Major Amputation in Persons with Diabetes and Ischaemic Foot Ulcers

Foot Angiosomes: Instructions for Use

Inframalleolar bypass for chronic limb-threatening ischemia

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