Infrapopliteal arterial revascularization for critical limb ischemia: Is the peroneal artery at the distal third a suitable outflow vessel?

Ballotta, Enzo; Giau, Giuseppe Da; Gruppo, Mario; Mazzalai, Franco; Martella, Bruno

doi:10.1016/j.jvs.2008.01.002

Cited by 23 publications

(16 citation statements)

References 25 publications

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“…In a retrospective series of 420 consecutive diabetic patients, Faglia et al observed that the reperfusion through the peroneal artery alone is not sufficient to avoid major amputation in some patients, but author did not analyze the peroneal distal branches patency [6]. However, other authors have found similar clinical results between peroneal artery and other tibial arteries after endovascular [25] or surgical bypass procedures [26]. In this sense, we argue that the disparity of the results between publications that have focused on foot outflow vessels could be explained in part by the lack of a foot anatomical ulcer classification and the absence of data about foot and ankle collateral patency in some studies.…”

Section: Discussionmentioning

confidence: 99%

Results of Infrapopliteal Endovascular Procedures Performed in Diabetic Patients with Critical Limb Ischemia and Tissue Loss from the Perspective of an Angiosome-Oriented Revascularization Strategy

Aciń

Varela

Maturana

et al. 2014

International Journal of Vascular Medicine

124

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Our aim was to describe our experience with infrapopliteal endovascular procedures performed in diabetic patients with ischemic ulcers and critical ischemia (CLI). A retrospective study of 101 procedures was performed. Our cohort was divided into groups according to the number of tibial vessels attempted and the number of patent tibial vessels achieved to the foot. An angiosome anatomical classification of ulcers were used to describe the local perfusion obtained after revascularization. Ischemic ulcer healing and limb salvage rates were measured. Ischemic ulcer healing at 12 months and limb salvage at 24 months was similar between a single revascularization and multiple revascularization attempts. The group in whom none patent tibial vessel to the foot was obtained presented lower healing and limb salvage rates. No differences were observed between obtaining a single patent tibial vessel versus more than one tibial vessel. Indirect revascularization of the ulcer through arterial-arterial connections provided similar results than those obtained after direct revascularization via its specific angiosome tibial artery. Our results suggest that, in CLI diabetic patients with ischemic ulcers that undergo infrapopliteal endovascular procedures, better results are expected if at least one patent vessel is obtained and flow is restored to the local ischemic area of the foot.

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Section: Discussionmentioning

confidence: 99%

Results of Infrapopliteal Endovascular Procedures Performed in Diabetic Patients with Critical Limb Ischemia and Tissue Loss from the Perspective of an Angiosome-Oriented Revascularization Strategy

Aciń

Varela

Maturana

et al. 2014

International Journal of Vascular Medicine

124

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show abstract

“…7,[13][14][15][16] Unlike an earlier analysis that identified different patency rates at tibial level, 14 but consistently with other authors, 8 we found that performing IARs with tibial arteries as target outflow vessels did not significantly affect the long-term patency and limb salvage rates in our two groups and subgroups, confirming previous findings of ours reported elsewhere. 17,19,20 Adopting an intensive postoperative protocol of graft surveillance led to many prophylactic lesion revisions being performed successfully in both sexes, explaining the marked improvement in the patency rates for failing (assisted primary patency) and failed revascularizations (secondary patency) at all intervals in both groups.…”

Section: Discussionmentioning

confidence: 99%

“…18 The peroneal artery was always exposed using a lateral approach requiring segmental fibulectomy. 19 The dorsalis pedis artery was often chosen as the outflow target artery as an alternative to a patent peroneal artery and when no tibial vessels were in direct continuity with the foot. Revascularization to the dorsalis pedis artery was avoided in cases of severe dorsal foot infection.…”

Section: Methodsmentioning

confidence: 99%

The impact of gender on outcome after infrainguinal arterial reconstructions for peripheral occlusive disease

Ballotta

Gruppo

Lorenzetti

et al. 2012

Journal of Vascular Surgery

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“…The number of patients suffering from chronic hind limb ischemia is increasing, and these patients urgently need revascularization treatment 1, 2. Angiogenesis originates from the proliferation and migration of endothelial cells and contributes to the formation of collateral circulation 3.…”

Section: Introductionmentioning

confidence: 99%

A cellular delivery system fabricated with autologous BMSCs and collagen scaffold enhances angiogenesis and perfusion in ischemic hind limb

Wang

Cui

et al. 2012

J Biomedical Materials Res

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Although therapeutic cellular angiogenesis is effective for chronic ischemia, the optimal mode of cellular administration is still under exploration. This study aimed to develop a cellular delivery system to enhance the perfusion and angiogenesis in the ischemic hind limb. Collagen scaffold (CS) was prepared, and for morphology and toxicity analysis, bone marrow-derived mesenchymal stem cells (BMSCs) were isolated, expanded, filtrated, and seeded onto CS to construct BMSCs-CS. The ischemic hind limbs of rabbit models were implanted with autologous BMSCs-CS, CS, and autologous BMSCs; the untreated ischemic or normal animals were considered as the ischemic or normal control groups. Oxygen saturation parameters were regularly measured to determine the perfusion in the extremities. Histological examinations with hematoxylin and eosin immunostaining against von Willebrand factor and smooth muscle (SM) α-actin were performed for capillary and mature vessel evaluation. CS was a multiporous structure without cytotoxicity. At several intervals, the oxygen saturation ratio (OSR) in normal control was the highest. The OSRs in BMSCs-CS and CS were higher than that in BMSCs and ischemic control (p < 0.05); the OSR in BMSCs-CS group was higher than that in CS at 6 and 8 weeks (p < 0.05). The capillaries in BMSCs-CS and CS were higher than that in CS, BMSCs, and the ischemic or normal control (p < 0.05). The mature vessels in BMSCs-CS were higher than that in CS, BMSCs, and the ischemic or normal control (p < 0.05). The autologous cellular delivery system proved to be an effective approach for improving higher ischemic hind limb perfusion and angiogenesis as opposed to cellular therapy alone.

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Infrapopliteal arterial revascularization for critical limb ischemia: Is the peroneal artery at the distal third a suitable outflow vessel?

Cited by 23 publications

References 25 publications

Results of Infrapopliteal Endovascular Procedures Performed in Diabetic Patients with Critical Limb Ischemia and Tissue Loss from the Perspective of an Angiosome-Oriented Revascularization Strategy

Results of Infrapopliteal Endovascular Procedures Performed in Diabetic Patients with Critical Limb Ischemia and Tissue Loss from the Perspective of an Angiosome-Oriented Revascularization Strategy

The impact of gender on outcome after infrainguinal arterial reconstructions for peripheral occlusive disease

A cellular delivery system fabricated with autologous BMSCs and collagen scaffold enhances angiogenesis and perfusion in ischemic hind limb

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