The role of foot collateral blood supply in the healing of ischemic wounds and limb salvage in patients with critical lower limb ischemia



Cite item

Full Text

Abstract

A retrospective evaluation of 192 endovascular interventions in patients with ischemic wounds, which were performed from November 2006 to March 2011. In accordance with the type of revascularization performed, patients were divided into the three groups. Direct revascularization (DR - the restoration of blood flow by the artery directly supplying the injured angiosome) was performed in 84 cases, indirect revascularization through the collateral vessel (IRC - the restoration of blood flow by the artery feeding the injured angiosome through the collateral vessel) - in 54 observations and indirect revascularization (IR - the restoration of blood supply to the foot in the absence of visible collateral vessels to the ischemic angiosome) - in 54 cases. Percentage of unhealed ulcers in DR, IRC and IR groups was 9%, 19% and 61% at 6 months and 2%, 4% and 27% at 12 months after ER, respectively. There were no statistical difference in healing time between DR and IRC groups (p=0,24). The healing process in patients of IR group was significantly longer, compared with DR and IRC groups (p<0,0001 in both cases). Limb salvage in DR, IRC, and IR groups was 99%, 100% and 90% at 6 months, 96%, 95% and 76% at 12 months and 96%, 90% and 64% at 3 years after ER, respectively. Limb salvage in IR group was significantly lower than in DR and IRC groups (p=0,01 when compared with DR group, p=0,03 when compared with IRC group), in which this parameter was not significantly different (p=0,65). Conclusions: Restoration of blood flow to the injured angiosome when ER is performed in patients with CLI significantly reduces healing time of ischemic ulcers of the foot and leads to a reduction of major amputation frequency. The results of IRC are not significantly different from the results of DR.

Full Text

Restricted Access

About the authors

S A Platonov

Janelidze Research Institute of Emergency Medicine, St. Petersburg

Email: sergey.platonov@mail.ru

M Yu Kaputin

Janelidze Research Institute of Emergency Medicine, St. Petersburg

D V Ovcharenko

Janelidze Research Institute of Emergency Medicine, St. Petersburg

S P Chistyakov

A A Voronkov

Janelidze Research Institute of Emergency Medicine, St. Petersburg

V V Zavacky

Janelidze Research Institute of Emergency Medicine, St. Petersburg

I P Dudanov

References

  1. Alexandrescu V.A., Hubermont G., Philips Y. et al. Selective primary angioplasty following an angiosome model of reperfusionin the treatment of Wagner 1-4 diabetic foot lesions: practice in amultidisciplinary diabetic limb sendee //J. Endovasc. Ther. 2008. Vol. 15. № 5. P. 580-593.
  2. Alexandrescu V.A., Vincent G., Azdad K. et al. A reliable approach to diabetic neuroischemic foot wounds: below-the-knee angiosome-oriented angioplasty // J. Endovasc. Ther. 20І1. Vol. 18. № 3. P. 376-387.
  3. Attinger C.E., Cooper P., Blume P., Bulan E. The safest surgical incision and amputations applying the angio somes principle and using the Doppler to assess the arterial-arterial connections of the foot and ankle // Foot Ankle Clin. 2001. Vol. 6. № 4. P. 745-799.
  4. Attinger C.E., Ducie I., Neville R.F. et al. The relative roles of aggressive wound care versus revascularization in salvage of the threatened lower extremity in the renal failure diabetic patient // Plast. Reconstr. Surg. 2002. Vol. 109. № 4. P. 1281-1290.
  5. Attinger C.E., Evans K.K., Bulan E. et al. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization // Plast. Reconstr. Surg. 2006. Vol. 117. Suppl. 7S. P. 261S-293S.
  6. Berceli S.A., Chan A.K., Pomposelli F.B. et al. Efficacy of dorsal pedal artery bypass in limb salvage for ischemic heel ulcers // J. Vase. Surg. 1999. Vol. 30. № 3. P. 499-508.
  7. Chernick M.R., Friis R.H. Introductory biostatistics for the health sciences: modern applications including bootstrap. New Jersey: John Wiley & Sons, 2003. 406 p.
  8. Cheshire N.J., Wolfe J.H.N. Does distal revascularization for limb salvage work? // Trials and tribulations of vascular surgery / R.M. Grcenhaugh, F.G.R. Fowkes. eds. Philadelphia: Saunders, 1996. P. 353-363.
  9. Deguchi J., Kitaoka T., Yamamoto K. et al. Impact of angiosome on treatment of diabetic ischemic foot with paramalleolar bypass // J. Jpn. Coll. Angiol. 2011. Vol. 50. № 6. P. 687-691.
  10. DeRubertis B.G., Pierce M., Chaer R.A. et al. Lesion severity and treatment complexity are associated with outcome after percutaneous infrainguinal intervention // J. Vase. Surg. 2007. Vol. 46. № 4. P. 709-716.
  11. Fernandez N., McEnaney R., Marone L.K. et al. Predictors of failure and success of tibial interventions for critical limb ischemia // J. Vase. Surg. 2010. Vol. 52. № 4. P. 834-842.
  12. Iida O., Nanto S., Uematsu M. et al. Importance of the angiosome concept for endovascular therapy in patients with critical limb ischemia // Cathet. Cardiovasc. Inters 2010. Vol. 75. № 6. P. 830-836.
  13. Neville R.F., Attinger C.E., Bulan E.J. et al. Revascularization of a specific angiosome for limb salvage: Does the target artery matter? // Ann. Vase. Surg. 2009. Vol. 23. № 3. P. 367-373.
  14. Prompers L., Schaper N., Apelqvist J. et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study // Diabetologia. 2008. Vol. 51.V» 5. P. 747-755.
  15. Söderström M., Aho P.S., Lepäntalo M., Albäck A. The influence of the characteristics of ischemic tissue lesions on ulcer healing time after infrainguinal bypass for critical leg ischemia // J. Vase. Surg. 2009. Vol. 49. № 4. p. 932-937.
  16. Söderström M., Arvela E. Albäck A. et al. Healing of ischaemic tissue lesions after infrainguinal bypass surgery for critical leg ischaemia // Eur. J. Vase. Endovasc. Surg. 2008. Vol. 36. № 1. P. 90-95.
  17. Taylor G.I., Palmer J.H. The vascular territories (angiosomes) of the body: Experimental study and clinical applications // Br. J. Plast. Surg. 1987. Vol. 40. № 2. P. 113-141.
  18. Taylor G.I., Pan W.R. Angiosomes of the leg: Anatomic study and clinical implications // Plast. Reconstr. Surg. 1998. Vol. 102. № 3. P. 599-616.
  19. Varela C., Acin F., de Haro J. et al. The role of foot collateral vessels on ulcer healing and limb salvage after successful endovascular and surgical distal procedures according to an angiosome model // Vase. Endovasc. Surg. 2010. Vol. 44. № 8. P. 654-660.
  20. Wagner F.W. The dysvascular foot: a system for diagnosis and treatment // Foot and Ankle. 1981. Vol. 2. №2. P. 64-122.
  21. Калугин М.Ю., Овчаренко Д.В., Платонов C.A., Дуданов И.П. Морфологическая характеристика поражении артерий нижних конечностей в отечественной популяции больных сахарным диабетом // Мел. акад. жури. 2009. Т. 9. № 1. С. 50-58.
  22. Капутин М.Ю., Овчаренко Д.В., Сорока В.В., Дуданов И.П., Боровский Н.Э. Транслюминальная баллонная ангиопластика в лечении критической ишемии нижних конечностей: Материалы XIV Всерос. съезда с/с хирургов. 9-12 ноября 2008 г. // Бюллетень НЦССХ им. Бакулева РАМН. М., 2008. Т. 9 (приложение). № 6. С. 113.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2011 Platonov S.A., Kaputin M.Y., Ovcharenko D.V., Chistyakov S.P., Voronkov A.A., Zavacky V.V., Dudanov I.P.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 74760 от 29.12.2018 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies