Commentary: Intra-arterial Digital Subtraction Angiography

Diehm, Nicolas

doi:10.1177/1526602815573231

Cited by 5 publications

(5 citation statements)

References 6 publications

(10 reference statements)

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“…In contrast, intra-arterial DSA may fail to correctly depict the anatomy of arteries of smaller diameter, especially distal to occlusions. [19][20][21][22][23][24] Thus, it cannot be ruled out that arterial obstructions classified as unsuitable for angioplasty based on diagnostic testing and criteria in the present investigation may have been overestimated. A parallel can be drawn from endovascular therapy of tibial arteries, where recanalization and angioplasty in the presence of visible arterial reconstitution distal to occlusions is standard therapy.…”

Section: Discussionmentioning

confidence: 99%

Lesion Pattern in Patients With Erectile Dysfunction of Suspected Arterial Origin

et al. 2015

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In this preliminary series of ED patients with cardiovascular risk factors and pathologic duplex sonographic flow parameters, roughly 40% exhibited arterial lesions amenable to endovascular revascularization. In the patients with macroangiopathy, vessels upstream of the internal pudendal artery were most commonly affected. More studies are warranted to define the role of endovascular procedures in this ED subpopulation.

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Section: Discussionmentioning

confidence: 99%

Lesion Pattern in Patients With Erectile Dysfunction of Suspected Arterial Origin

et al. 2015

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“…17,33,34,38,40,43 In these cases scarce “dormant” or “latent” foot collaterals distal to long and highly calcified tibial occlusions may foster suboptimal interpretation. 47…”

Section: Discussionmentioning

confidence: 99%

“…According to contemporary observation, 19,47 DSA still represents a purely luminographic imaging modality that is impacted by the individual hemodynamic situation of the patient and the position of the sheath. 47 Perfusion iconography based on flow-contrast technology can just barely depict tiny circulatory changes inside the severely diseased diabetic ischemic foot. 8,19,34,40,47…”

Section: Discussionmentioning

confidence: 99%

“…47 Perfusion iconography based on flow-contrast technology can just barely depict tiny circulatory changes inside the severely diseased diabetic ischemic foot. 8,19,34,40,47…”

Section: Discussionmentioning

confidence: 99%

“…17,33,34,38,40,43 In these cases scarce "dormant" or "latent" foot collaterals distal to long and highly calcified tibial occlusions may foster suboptimal interpretation. 47 It should also be noted that about a third of cases enrolled in this study had a distal "low-flow" limb owing to severe cardiac insufficiency, which may have added hurdles in precisely evaluating small arterial branches.…”

Section: Limitationsmentioning

confidence: 97%

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Healing of Diabetic Neuroischemic Foot Wounds With vs Without Wound-Targeted Revascularization: Preliminary Observations From an 8-Year Prospective Dual-Center Registry

Alexandrescu¹,

Brochier²,

Limgba³

et al. 2019

J Endovasc Ther

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Purpose: To assess the clinical efficacy of endovascular angiosome-oriented wound-targeted revascularization (WTR) vs indirect (wound-indifferent) revascularization (IR) in diabetic patients with neuroischemic foot ulcers. Materials and Methods: Between April 2009 and July 2017, 167 diabetic patients (mean age 72.8 years; 137 men) with chronic limb-threatening ischemia (Rutherford category 5) and foot wounds (Wagner 2–4) in 194 limbs were prospectively registered and scheduled for primary infragenicular endovascular treatment. Specific angiosome source artery reperfusion sustained by patent foot arches or arterial-arterial connections was attempted initially. If this approach failed, topographic revascularization via available collaterals (WTRc) and IR were sequentially attempted. Results: Reperfusion was successful in 176 (91%) of 194 limbs (113 with WTR, 28 with WTRc, and 35 with IR); the global angiosome-oriented technical success (WTR and WTRc) was 73% (141/194). The mean follow-up was 10.9±0.7 months (range 3–12.5). Over 1 year, 102 (58%) of the 176 successfully treated limbs experienced wound healing [79/113 (70%) in the WTR group, 15/28 (54%) in the WTRc group, and 7/35 (20%) in the IR group; p=0.011]. The mean time to healing was 6.8±0.4 months in the WTR group, 7.9±0.6 months in the WTRc group, and 9.8±0.7 months in the IR group (p=0.001). Relapses were noted in 18 (16%) WTR limbs, 5 (18%) WTRc limbs, and 6 (17%) IR limbs. Comparison between WTR and IR and WTRc vs IR showed improved cicatrization in the angiosome-oriented groups (p<0.05). Major adverse limb events (MALE) and limb salvage were different between WTR and WTRc and between WTR and IR groups (p<0.05), while WTRc vs IR was not. Amputation-free survival was not influenced by the revascularization strategy (p=0.093). Conclusion: Wound healing in diabetic patients with chronic limb-threatening ischemia appeared to be improved by intentional wound-targeted revascularization, but no uniform benefit concerning MALE or limb preservation was observed. IR still represents an alternative for limb salvage in cases in which angiosome-guided revascularization fails.

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Angiosome System and Principle

Alexandrescu¹,

Defraigne²

2018

Textbook of Catheter-Based Cardiovascular Interventions

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Commentary: Intra-arterial Digital Subtraction Angiography

Cited by 5 publications

References 6 publications

Lesion Pattern in Patients With Erectile Dysfunction of Suspected Arterial Origin

Lesion Pattern in Patients With Erectile Dysfunction of Suspected Arterial Origin

Healing of Diabetic Neuroischemic Foot Wounds With vs Without Wound-Targeted Revascularization: Preliminary Observations From an 8-Year Prospective Dual-Center Registry

Angiosome System and Principle

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