PMID- 38337576 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240212 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 13 IP - 3 DP - 2024 Feb 2 TI - Angiosome-Targeted Infrapopliteal Angioplasty: Impact on Clinical Outcomes-An Observational Study. LID - 10.3390/jcm13030883 [doi] LID - 883 AB - Background: Revascularization based on the angiosome concept (AC) is a controversial subject because there is currently no clear evidence of its efficacy, due to the heterogeneity of patients (multiple and diverse risk factors and comorbidities, multiple variations in the affected angiosomes). Choke vessels change the paradigm of the AC, and the presence or absence of the plantar arch directly affects the course of targeted revascularization. The aim of this study was to evaluate the effect of revascularization based on the AC in diabetic patients with chronic limb-threatening ischemia (CLTI). Methods: This retrospective analysis included 51 patients (40 men, 11 women), with a mean age of 69 years (66-72) and a total of 51 limbs, who presented with Rutherford 5-6 CLTI, before and after having undergone a drug-coated balloon angioplasty (8 patients) or plain balloon angioplasty (43). Between November 2018 and November 2019, all patients underwent below-the-knee balloon angioplasties and were followed up for an average of 12 months. The alteration of microcirculation was compared between directly and indirectly revascularized angiosomes. The study assessed clinical findings and patient outcomes, with follow-up investigations, comparing wound healing rates between the different revascularization methods. Patient records and periprocedural leg digital subtraction angiographies (DSA) were analyzed. Differences in outcomes after direct revascularization and indirect percutaneous transluminal angioplasty (PTa) were examined using Cox proportional hazards analysis, with the following endpoints: ulcer healing, limb salvage, and also amputation-free survival. Results: Direct blood flow to the angiosome supplying the ulcer area was achieved in 38 legs, in contrast to 13 legs with indirect revascularization. Among the cases, there were 39 lesions in the anterior tibial artery (ATA), 42 lesions in the posterior tibial artery (PTA), and 8 lesions in the peroneal artery (PA). According to a Cox proportional hazards analysis, having fewer than three (<3) affected angiosomes (HR 0.49, 95% CI 0.19-1.25, p = 0.136) was associated with improved wound healing. Conversely, wound healing outcomes were least favorable after indirect angioplasty (p = 0.206). When adjusting the Cox proportional hazard analysis for the number of affected angiosomes, it was found that direct drug-coated angioplasty resulted in the most favorable wound healing (p = 0.091). At the 1-year follow-up, the major amputation rate was 17.7%, and, according to a Cox proportional hazards analysis, atrial fibrillation (HR 0.85, 95% CI 0.42-1.69, p = 0.637), hemodialysis (HR 1.26, 95% CI 0.39-4.04, p = 0.699), and number of affected angiosomes > 3 (HR 0.94, 95% CI 0.63-1.39, p = 0.748) were significantly associated with poor leg salvage. Additionally, direct endovascular revascularization was associated with a lower rate of major amputation compared to indirect angioplasty (HR 1.09, 95% CI 0.34-3.50, p = 0.884). Conclusions: Observing the angiosomes concept in decision-making appears to result in improved rates of arterial ulcer healing and leg salvage, particularly in targeted drug-coated balloon angioplasty for diabetic critical limb ischemia, where multiple angiosomes are typically affected. FAU - Popitiu, Mircea Ionut AU - Popitiu MI AD - Research Center in Vascular and Endovascular Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania. FAU - Alexandrescu, Vlad Adrian AU - Alexandrescu VA AUID- ORCID: 0000-0002-9181-7993 AD - Cardio-Vascular and Thoracic Surgery Department, CHUp Sart-Tilman Hospital, University of Liege, 4000 Liege, Belgium. FAU - Clerici, Giacomo AU - Clerici G AD - San Carlo Clinic, 20026 Paderno Dugnano, Italy. FAU - Ionac, Stefan AU - Ionac S AUID- ORCID: 0000-0002-4016-8153 AD - Research Center in Vascular and Endovascular Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania. FAU - Gavrila-Ardelean, Gloria AU - Gavrila-Ardelean G AUID- ORCID: 0009-0002-9916-0778 AD - Research Center in Vascular and Endovascular Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania. FAU - Ion, Miruna Georgiana AU - Ion MG AD - Research Center in Vascular and Endovascular Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania. FAU - Ionac, Mihai Edmond AU - Ionac ME AUID- ORCID: 0000-0002-9214-302X AD - Research Center in Vascular and Endovascular Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania. LA - eng PT - Journal Article DEP - 20240202 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC10856460 OTO - NOTNLM OT - angiosome concept OT - critical limb-threatening ischemia OT - diabetes OT - drug-coated balloon OT - percutaneous transluminal angioplasty COIS- The authors declare no conflicts of interest. EDAT- 2024/02/10 10:45 MHDA- 2024/02/10 10:46 PMCR- 2024/02/02 CRDT- 2024/02/10 01:04 PHST- 2023/12/26 00:00 [received] PHST- 2024/01/22 00:00 [revised] PHST- 2024/01/26 00:00 [accepted] PHST- 2024/02/10 10:46 [medline] PHST- 2024/02/10 10:45 [pubmed] PHST- 2024/02/10 01:04 [entrez] PHST- 2024/02/02 00:00 [pmc-release] AID - jcm13030883 [pii] AID - jcm-13-00883 [pii] AID - 10.3390/jcm13030883 [doi] PST - epublish SO - J Clin Med. 2024 Feb 2;13(3):883. doi: 10.3390/jcm13030883.