PMID- 28756043 OWN - NLM STAT- MEDLINE DCOM- 20171030 LR - 20221207 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 66 IP - 5 DP - 2017 Nov TI - Impact of angiosome- and nonangiosome-targeted peroneal bypass on limb salvage and healing in patients with chronic limb-threatening ischemia. PG - 1479-1487 LID - S0741-5214(17)31593-8 [pii] LID - 10.1016/j.jvs.2017.04.074 [doi] AB - BACKGROUND: Direct (DIR) or indirect (IND) revascularization of pedal angiosomes in patients with chronic limb-threatening ischemia (CLTI) has an unclear impact on limb salvage and healing. The aim of this study was to evaluate the outcomes of DIR and IND revascularization in patients with a peroneal bypass and tissue loss. METHODS: We conducted a retrospective study of a prospectively maintained database in two European university centers from 2004 to 2015. We extracted from this database all patients with CLTI and tissue loss who had received a bypass to the peroneal artery. All patients underwent angiography before bypass. Revascularization was considered DIR if the wound was in a peroneal angiosome. Wounds, ischemia, and infection were categorized according to the Wound, Ischemia, and foot Infection (WIfI) classification. Limb salvage and amputation-free survival were calculated using the Kaplan-Meier method. Cox regression was used to compare the role of patient characteristics, including diabetes, peroneal runoff, pedal arch angiosome, WIfI grade, chronic kidney disease, and diabetes, in amputation-free-survival. RESULTS: From January 2004 through October 2015, there were 120 peroneal bypasses performed in 120 patients with CLTI and foot tissue loss. Only 55 wounds (46%) could be ascribed to a peroneal angiosome. At 3 years, amputation-free survival in patients with DIR revascularization was 54.9% +/- 7.3% compared with 56.5% +/- 6.3% in patients with IND revascularization (P = .44), with no significant difference in wound healing. Amputation-free survival at 3 years in patients with two patent peroneal branches was 74.8% +/- 6.9% compared with 45.0% +/- 6.0% in patients with one patent peroneal branch (P = .003). Amputation-free survival at 3 years in patients with a patent pedal arch (Rutherford 0-1) was 73.0% +/- 7.0% vs 45.7% +/- 6.0% in patients with incomplete pedal arch (Rutherford 2-3; P = .0002). Amputation-free survival at 3 years in patients with grade 1 or grade 2 WIfI was 87.4% +/- 8.3% compared with 48.4% +/- 5.3% in patients with grade 3 or grade 4 WIfI (P = .001). Amputation-free survival at 3 years in patients with diabetes was 43.7% +/- 6.2% compared with 73.1% +/- 6.7% in patients without diabetes (P = .002). Wound healing at 6 months was not significantly improved by its location within or outside a peroneal angiosome. Cox regression analysis demonstrated that diabetes, patency of both peroneal branches, patency of pedal arch, and WIfI stage but not DIR angiosome revascularization were significant predictors of amputation-free survival. CONCLUSIONS: Our results suggest that in patients with CLTI and tissue loss receiving a peroneal bypass, patency of both peroneal branches and pedal arch was associated with a better healing rate and a better amputation-free survival rate irrespective of wound angiosome location. CI - Copyright (c) 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Ricco, Jean-Baptiste AU - Ricco JB AD - Department of Vascular Surgery, University Hospital of Poitiers, Poitiers, France. Electronic address: jean.baptiste.ricco@univ-poitiers.fr. FAU - Gargiulo, Mauro AU - Gargiulo M AD - Department of Vascular Surgery, University of Bologna "Alma Mater Studiorum," DIMES, Policlinico S. Orsola Malpighi, Bologna, Italy. FAU - Stella, Andrea AU - Stella A AD - Department of Vascular Surgery, University of Bologna "Alma Mater Studiorum," DIMES, Policlinico S. Orsola Malpighi, Bologna, Italy. FAU - Abualhin, Mohammad AU - Abualhin M AD - Department of Vascular Surgery, University of Bologna "Alma Mater Studiorum," DIMES, Policlinico S. Orsola Malpighi, Bologna, Italy. FAU - Gallitto, Enrico AU - Gallitto E AD - Department of Vascular Surgery, University of Bologna "Alma Mater Studiorum," DIMES, Policlinico S. Orsola Malpighi, Bologna, Italy. FAU - Desvergnes, Mathieu AU - Desvergnes M AD - Department of Vascular Surgery, University Hospital of Poitiers, Poitiers, France. FAU - Belmonte, Romain AU - Belmonte R AD - Department of Vascular Surgery, University Hospital of Poitiers, Poitiers, France. FAU - Schneider, Fabrice AU - Schneider F AD - Department of Vascular Surgery, University Hospital of Poitiers, Poitiers, France. LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study DEP - 20170726 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Academic Medical Centers MH - Adult MH - Aged MH - Aged, 80 and over MH - Amputation, Surgical MH - *Blood Vessel Prosthesis Implantation/adverse effects MH - Chi-Square Distribution MH - Chronic Disease MH - Databases, Factual MH - Disease-Free Survival MH - Female MH - France MH - Humans MH - Ischemia/diagnostic imaging/physiopathology/*surgery MH - Italy MH - Kaplan-Meier Estimate MH - *Limb Salvage MH - Lower Extremity/*blood supply MH - Male MH - Middle Aged MH - *Models, Cardiovascular MH - Multivariate Analysis MH - Peripheral Arterial Disease/diagnostic imaging/physiopathology/*surgery MH - Predictive Value of Tests MH - Proportional Hazards Models MH - Retrospective Studies MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - Vascular Patency MH - Veins/*transplantation MH - *Wound Healing MH - Wound Infection/microbiology EDAT- 2017/08/02 06:00 MHDA- 2017/10/31 06:00 CRDT- 2017/07/31 06:00 PHST- 2017/01/12 00:00 [received] PHST- 2017/04/30 00:00 [accepted] PHST- 2017/08/02 06:00 [pubmed] PHST- 2017/10/31 06:00 [medline] PHST- 2017/07/31 06:00 [entrez] AID - S0741-5214(17)31593-8 [pii] AID - 10.1016/j.jvs.2017.04.074 [doi] PST - ppublish SO - J Vasc Surg. 2017 Nov;66(5):1479-1487. doi: 10.1016/j.jvs.2017.04.074. Epub 2017 Jul 26.