Impact of Angiosome-Oriented Revascularization on Clinical Outcomes in Critical Limb Ischemia Patients Without Concurrent Wound Infection and Diabetes

Iida, Osamu; Takahara, Mitsuyoshi; Soga, Yoshimitsu; Yamauchi, Yasutaka; Hirano, Keisuke; Tazaki, Junichi; Yamaoka, Terutoshi; Suematsu, Nobuhiro; Suzuki, Kenji; Shintani, Yoshiaki; Miyashita, Yusuke; Uematsu, Masaaki

doi:10.1583/14-4692r.1

Cited by 48 publications

(73 citation statements)

References 18 publications

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“…As previously described [23,24], the foot angiosomes are 3-D dynamic and continuously interacting structures [30]. Although their primary anatomical distribution seems accurately reproduced in more than 90% of subjects (owing 6-9% eventual anatomival variants) [23,24,26,91], their interconnections ("choke vessels") are yet submitted to continuous changes, according to each type of CLI pathology [72,[95][96][97][98].…”

Section: The "Angiosome Concept" In Ischemic Wound Healing: a Succincmentioning

confidence: 90%

“…These vascular territories are closely interconnected by numerous arterial-arterial communicants [23,24], whose caliber and density are strongly influenced by the age of patients, by each region's anatomy and by the manifest arterial disease triggering CLI [24,35,72,[96][97][98]. Every individual collateral system essentially assists blood supply between neighboring angiosomes.…”

Section: The "Angiosome Concept" In Ischemic Wound Healing: a Succincmentioning

confidence: 99%

“…Inasmuch genetic collateral network warrants a remarkable "rescue system" in non-atherosclerotic patients, it can be dramatically hindered in specific diabetic or uremic ischemic wounds [24,35,72,[96][97][98]. The interventionist should be aware of treating peculiar diabetic and ESRD ischemic ulcers, for that these patients may hide huge collateral decay and poor arterial-arterial connections among adjacent foot angiosomes [72,97].…”

Section: What Group Of Ischemic Ulcers May Need Wdr?mentioning

confidence: 99%

“…Alternatively, the use of WDR principle in these cases seems to provide improved healing results [24,39,72,[96][97][98] owning scrupulous macro-and microcirculatory evaluation, planning for intervention and follow-up [39,96,97].…”

Section: What Group Of Ischemic Ulcers May Need Wdr?mentioning

confidence: 99%

“…Growing clinical expertise, however, seems to support WDR in "lowcollateral" CLI patients such as those presenting DFS (Figures 2 and 3), or ESRD ischemic wounds [72,[91][92][93][96][97][98].…”

Section: What Group Of Ischemic Ulcers May Need Wdr?mentioning

confidence: 99%

See 4 more Smart Citations

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

Alexandrescu¹,

Triffaux²

2016

Wound Healing - New Insights Into Ancient Challenges

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During the recent decades, soaring progresses in vascular disease knowledge, particularly in critical limb ischemia (CLI) treatment, enhanced novel diagnostic and interventional strategies with high serviceableness in patient's selection, arterial recanalization, and dedicated ischemic ulcer follow-up. However, despite undeniable advances in medical technology and clinical judgment, limb salvage, the ambulation recovery, and patient's survival seem only scarcely affected in this heterogeneous CLI group, particularly concerning the diabetic and renal patients. Innovative strategies such as "end artery occlusive disease" treatment or "wound-targeted revascularization" were equally proposed by following the angiosomal anatomical distribution associating individual foot collateral assessment in a unified macro-and micro-circulatory judgment. However, despite encouraging clinical results, prospective evidence still lacks on this concern. It also appears that specific wounds could not always stand for the lowest perfusion areas according to current CLI criteria, since severe neuropathy, inflammatory swelling, local infection, and skin trauma may add complementary hindrances to tissue viability.The present chapter endeavor to summarize main available treatment principles for ischemic ulcer recovery that every modern practitioner eventually disposes in an updated contemporary view."

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Section: The "Angiosome Concept" In Ischemic Wound Healing: a Succincmentioning

confidence: 90%

Section: The "Angiosome Concept" In Ischemic Wound Healing: a Succincmentioning

confidence: 99%

Section: What Group Of Ischemic Ulcers May Need Wdr?mentioning

confidence: 99%

Section: What Group Of Ischemic Ulcers May Need Wdr?mentioning

confidence: 99%

Section: What Group Of Ischemic Ulcers May Need Wdr?mentioning

confidence: 99%

See 3 more Smart Citations

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

Alexandrescu¹,

Triffaux²

2016

Wound Healing - New Insights Into Ancient Challenges

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Clinical impact of intravascular ultrasound‐guided balloon angioplasty in patients with chronic limb threatening ischemia for isolated infrapopliteal lesion

Soga

Takahara

Ito

et al. 2020

Cathet Cardio Intervent

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Background To estimate the impact of intravascular ultrasound (IVUS) in patients with chronic limb‐threatening ischemia (CLTI) who underwent balloon angioplasty for isolated infrapopliteal lesion. Methods The study was performed as a single‐center, prospective maintained database, retrospective analysis. Between January 2013 and December 2018, consecutive 155 CLTI patients (155 limbs) who primarily underwent balloon angioplasty for de novo isolated infrapopliteal atherosclerotic lesions with Rutherford category class 4 or 5 were identified (IVUS‐guided: 92 patients, angio‐guided: 63 patients) and included in the analysis. We compared clinical outcomes in IVUS‐guided group with that in angio‐guided group. The primary endpoint was limb salvage without any reintervention. The main secondary endpoints were wound healing rate and time to wound healing in the tissue loss group. Result Patient and limb characteristics were similar between the two groups. The IVUS‐guided group was treated with a larger balloon size for all types of below‐the‐knee vessel (p < .001), although lesion characteristics, including the QVA‐measured vessel diameter, were similar between the two groups. The IVUS‐guided group had a higher rate of limb salvage without any reintervention than the angio‐guided group (p = 0028). Whereas limb salvage and overall survival was not significantly different. Wound healing was significantly earlier and the time to wound healing was significantly shorter (84 ± 55 days vs. 135 ± 118 days, p = .007) in the IVUS‐guided group. Conclusion Limb salvage rate without any reintervention in IIVUS‐guided balloon angioplasty group was significantly higher than that in angio‐guided balloon angioplasty group in patients with CLTI due to isolated infrapopliteal disease.

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Endovascular Revascularisations: When and How

Patrone,

Zayed

2023

Management of Diabetic Foot Complications

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Impact of Angiosome-Oriented Revascularization on Clinical Outcomes in Critical Limb Ischemia Patients Without Concurrent Wound Infection and Diabetes

Abstract: After propensity matching analysis for CLI patients other than those with both diabetes and wound infection, the wound healing rate was higher after direct revascularization than after indirect revascularization, whereas MALE and AFS were not significantly different.

Cited by 48 publications

References 18 publications

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

Clinical impact of intravascular ultrasound‐guided balloon angioplasty in patients with chronic limb threatening ischemia for isolated infrapopliteal lesion

Endovascular Revascularisations: When and How

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