The Role of Foot Collateral Vessels on Ulcer Healing and Limb Salvage After Successful Endovascular and Surgical Distal Procedures According to an Angiosome Model

Abstract

Ulcer blood flow restoration through collateral vessels may give similar results to those obtained through its specific source artery.

Endovascular Treatment of Diabetic Foot in a Selected Population of Patients with Below-the-Knee Disease: Is the Angiosome Model Effective?

“…In 203 consecutive patients with CLI treated endovascularly, Iida et al [38] reported 86 % of limb salvage rate in the DR group compared to 69 % in the IR group. Similar results were reported by Varela et al [39] and by Alexandrescu et al [40], documenting how the treatment of diabetic patients with CLI throughout DR provide better results in terms of limb salvage and ulcer healing than IR.…”

“…At our institute, the first treatment option is DR, a strategy that is in line with data from the literature [37][38][39][40]. Only in cases of technical impossibility of DR do we turn to our second choice, the indirect approach.…”

“…In our opinion, the DR technique, according to the literature [37][38][39][40], should be the first therapeutic choice; however, if DR treatment is not feasible, then the IR technique is a valid and similarly effective procedure.…”

“…DR is considered the treatment of an artery that is a direct tributary of the involved angiosome, whereas IR is intended as the treatment of an artery that is not a direct tributary of the involved angiosome [37]. Studies seem to favor the effectiveness of DR according to the angiosome model [37][38][39][40].…”

Is Limb Loss Always Inevitable for Critical Neuro-Ischemic Foot Wounds in Diabetic Patients with End Stage Renal Disease and Unfit for Vascular Reconstructions?

“…The concept delineates the human body in specific 3D blocks of tissue, fed by peculiar arterial and venous bundles of blood supply (Attinger et al, 2001(Attinger et al, , 2006Taylor et al, 1990Taylor et al, , 1998. Originally pioneered for the pediculated flaps techniques, the AM strategy (Attinger et al, 2006;Taylor et al, 1998) was also applied to improve healing in lower limb ischemic ulcers (Alexandrescu et al, 2008;Neville et al, 2009;Varela et al, 2010;Setacci et al, 2010). Based on the anatomical studies of Taylor (Taylor et al, 1990(Taylor et al, , 1998 and Attinger (Attinger et al, 2001(Attinger et al, , 2006, new preferential strategies for vascular access, revascularization or amputation were described.…”