PMID- 34076565
OWN - NLM
STAT- MEDLINE
DCOM- 20220328
LR  - 20221207
IS  - 0001-5458 (Print)
IS  - 0001-5458 (Linking)
VI  - 122
IP  - 2
DP  - 2022 Apr
TI  - The impact of an angiosome-targeted revascularization on healing rate, limb 
      salvage and survival in critical limb threatening ischemia.
PG  - 107-115
LID - 10.1080/00015458.2021.1881337 [doi]
AB  - OBJECTIVE: According to the angiosome concept ulcer healing and limb salvage 
      should be superior if direct arterial flow to the source vessel of an affected 
      angiosome is established compared to indirect flow where the angiosome is 
      perfused by means of collaterals. The objective of this study was to evaluate the 
      impact of direct versus indirect revascularization (DR/IR) in endovascular versus 
      bypass surgery on ulcer healing, limb salvage and mortality. MATERIALS AND 
      METHODS: A retrospective analysis of both endovascular and bypass distal (below 
      the knee) lower limb revascularizations for chronic limb-threatening ischemia 
      (CLTI) between 1993 and 2014 was performed. RESULTS: The study population 
      consisted of 126 endovascular and 198 bypass procedures. DR and IR were achieved 
      in 57.4% and 42.6% limbs respectively. DR was not superior to IR regarding all 
      three major endpoints when endovascular and bypass procedures were analyzed 
      separately. Endovascular and bypass procedures resulted in comparable healing 
      rates. All patients who did not achieve wound healing (HR 7.49; 95% CI 
      4.25-13.20, p = .0001) or needed to be treated with a bypass (HR 1.79; 95% CI 
      1.05-3.05, p = .034) were at an increased risk for major amputation. Increased 
      mortality rate was noted after endovascular procedures (HR 1.45; 95% CI 
      1.04-2.00, p = .026). CONCLUSION: This retrospective study with comparable 
      results for DR and IR did not support the angiosome concept. Achieving wound 
      healing remains critical in patients with CLTI to reduce major amputation rates. 
      Overall the implications of the angiosome concept seem to be limited due to its 
      feasibility in patients with CLTI.
FAU - Croo, Alexander
AU  - Croo A
AD  - Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, 
      Belgium.
FAU - Versyck, Timothy
AU  - Versyck T
AD  - Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, 
      Belgium.
FAU - Duinslaeger, Alec
AU  - Duinslaeger A
AD  - Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, 
      Belgium.
FAU - Harth, Charlotte
AU  - Harth C
AD  - Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, 
      Belgium.
FAU - Vermassen, Frank
AU  - Vermassen F
AD  - Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, 
      Belgium.
FAU - Randon, Caren
AU  - Randon C
AD  - Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, 
      Belgium.
LA  - eng
PT  - Journal Article
DEP - 20210621
PL  - England
TA  - Acta Chir Belg
JT  - Acta chirurgica Belgica
JID - 0370571
SB  - IM
MH  - Amputation, Surgical
MH  - *Endovascular Procedures/adverse effects
MH  - Humans
MH  - Ischemia/surgery
MH  - *Limb Salvage/methods
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Wound Healing
OTO - NOTNLM
OT  - Angiosome concept
OT  - direct and indirect revascularization
OT  - major amputation
OT  - wound healing
EDAT- 2021/06/03 06:00
MHDA- 2022/03/29 06:00
CRDT- 2021/06/02 12:16
PHST- 2021/06/03 06:00 [pubmed]
PHST- 2022/03/29 06:00 [medline]
PHST- 2021/06/02 12:16 [entrez]
AID - 10.1080/00015458.2021.1881337 [pii]
AID - 10.1080/00015458.2021.1881337 [doi]
PST - ppublish
SO  - Acta Chir Belg. 2022 Apr;122(2):107-115. doi: 10.1080/00015458.2021.1881337. Epub 
      2021 Jun 21.