Utility of direct angiosome revascularization and runoff scores in predicting outcomes in patients undergoing revascularization for critical limb ischemia

Abstract

DR according to pedal angiosomes provides more efficient wound healing, but is possible in only one-half of the patients and does not affect amputation-free or overall survival. DR is associated with improved runoff scores, but current runoff scores have little clinical utility in predicting outcomes in CLI patients.

Immediate changes of angiosome perfusion during tibial angioplasty

“…These results are in accordance with findings of our previous studies as well as with several studies evaluating the influence of the selected bypass target artery on wound healing. 2,8,27 For example, Azuma et al 8 could not find a significant difference concerning wound healing and limb salvage for DR angiosomes after tibial bypass surgery. However, these results are in contradiction to several retrospective findings of recently published studies.…”

Number of infrapopliteal arteries undergoing endovascular treatment is not associated with the limb salvage rate in patients with critical limb ischemia

“…[10][11][12] The Bollinger classification was determined for the infrapopliteal arteries and plantar arch but not for the femoropopliteal arteries. The concordance between the two independent examiners was 0.71 (r ¼ 0.71, Pearson test), which was considered satisfactory.…”

“…The plantar arch was classified as a complete plantar arch (CPA), incomplete plantar arch (IPA), or absent plantar arch (APA). [10][11][12] CPA was defined as the presence of both dorsalis pedis arteries and at least one plantar artery, with the communication of these arteries through the deep plantar artery or lateral tarsal artery. IPA was defined as the presence of one pedal artery but no plantar arch.…”

Commentary: Myths and Proofs of Angiosome Applications in CLI: Where Do We Stand?

“…More refined information is now available regarding the ''choke vessels'' 1,2 that connect the foot angiosomes 1,2,4,16 in specific populations, such as diabetic 3,7,8,18,27 or renal 16,24,25 patients with scarce collateral reserve. 7,16 Identification of the importance of the foot arches, 2,14 the large (.0.5 mm) arterial-arterial collaterals, 2,4,16,28 and the key role of metatar-sal perforators 2,8,[15][16][17] has also occurred since wound-oriented vs. blind revascularization was conceived. 2,4,[14][15][16] In keeping with this advance in knowledge about the angiosome concept, the article by Iida et al 10 offers the reader new insights into applying the angiosome strategy in current BTK practice.…”