Impact of angiosomal concept in tibial angioplasty on diabetic foot management and limb survival. | ||
| The Egyptian Journal of Surgery | ||
| Volume 43, Issue 4, October 2024, Pages 1455-1462 PDF (607.77 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/EJSUR.2024.293566.1089 | ||
| Authors | ||
| Ahmed A. Shaker* ; Mohammed A. Hassan; Ahmed A. Elnaggar; Ahmed R. Tawfik | ||
| Department of Vascular and Endovascular Surgery, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt | ||
| Abstract | ||
| Introduction: The concept of angiosomes plays a crucial role in revascularization strategies for critical limb-threatening ischemia. Angiosomes are three-dimensional blocks of tissue supplied by specific arteries. Angiosome-directed revascularization aims to restore blood flow to the ischemic tissue by targeting the specific angiosome affected by the arterial occlusion. Aim: This study aims to determine whether to predict better diabetic foot wound healing angiosome or nonangiosome tibial angioplasty revascularization strategy or the overall wound, ischemia, and foot infection (WIFI) grade of the diabetic foot. Patients and Methods: A prospective nonrandomized comparative clinical study was conducted between December 2018 and June 2021 in a single tertiary referral center. The patients signed an institutional approved informed consent, and the university institutional review board approved the present study. Results: We performed a total of 100 infrapopliteal endovascular procedures in 110 limbs from 100 consecutive patients. Patients were divided into two groups according to angiosomal concept, direct group and indirect group. Each group included 50 patients. There was no significant difference between the two groups, 63.7±6.7 and 64.57±7.2, respectively, in the direct and indirect groups. There was no significant difference between the two groups regarding the site of the lesion, the WIFI stage, and the lesion severity scoring system (global limb anatomic staging system) for infrapopliteal disease analysis. However, there was a significant difference between the two groups regarding the treatment of the artery with angioplasty. The healing rate in foot lesions among the nonangiosome group and patients with WIFI (II) were statistically significantly higher than among angiosome group and patients with WIFI (III); 84.6 and 78.2% versus 15.38 and 21.79%, respectively; there was statistical significance difference in the healing rate of foot lesions in the group WIFI (II) more than WIFI (III) 142 days versus 256 days. There was no statistically significant difference (P>0.05) between both groups with major amputation, minor amputation, persistent wound, and death. However, there was a significance difference concerning limb salvage (P=0.045). Conclusion: Our results coincide with what was published that the limb scoring severity system (WIFI) is more important than angiosome revascularization in wound healing rate, limb survival rate, and amputation-free survival. | ||
| Keywords | ||
| Angioplasty; angiosomal; survival; tibial | ||
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