Courtesy of Dr. Carlos Fava.
Critical limb ischemia (CLI) accompanied by tissue loss entails high risk of amputation. At present, there is substantial evidence in favor of revascularization by PCI according to the angiosome concept, but the feasibility of this treatment remains unclear.
161 compromised limbs were analyzed in 160 patients with foot ulcers undergoing below-the-knee (BTK) interventions. Mean age was 75, and 67% of patients were diabetic. They were all 5 or 6 Rutherford stage.
Lesions were associated to:
- Only one angiosome in 39 patients (24%)
- 2 angiosomes in 75 patients (46.6%)
- 3 angiosomes in 42 patients (26.1%)
- 4 angiosomes in 4 patients (2.5%)
- 5 angiosomes in 1 patient (0.6%)
Direct flow to the affected angiosome was achieved in 98 patients (60.9%). Researchers analyzed the number of angiosomes associated to ulcers and revascularization success rate. If ulcers were associated to:
- 1 angiosome, revascularization was successful in 27 patients (69.2%)
- 2 angiosomes, it was successful in 65 patients (86.7%)
- 3 angiosomes, it was successful in 36 patients (85.7%)
- 4 angiosomes, it was successful in 1 patient (25%)
- 5 angiosomes, there was no chance of revascularization
Conclusion
In critical limb ischemia, tissue lesions mostly affect several angiosomes. In the literature published so far, there is evidence on angiosome targeted revascularization when more than one angiosome is compromised and we need consensus to achieve an exact definition.
Editorial Comment
Cases of CLI are dramatically increasing, and they are accompanied by a significant rate of amputation.
Multiple publications have shown the benefits of the angiosome concept and this analyzis shows it is feasible in little more than half of patients.
We should incorporate the concept of angiosome targeted revascularization in CLI knowing that it involves longer procedural time, the need of new strategies and new materials to become more effective with this group of patients.
Courtesy of Dr. Carlos Fava. Favaloro Foundation, Buenos Aires, Argentina.
Original Title: The Feasibility of Angisome-Targeted Endovascular Treatment in Patients with Critical Limb Ischemia and Foot Ulcer.
Reference: Kristýna Spillerová et al. Ann Vasc Surg 2016;30:20-70-276.
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