Donghua Ji MD

The interventional therapy Department of the 1st Hospital of

Dalian Medical University, China

DP, dorsalis pedis artery angiosome; LP, lateral plantar artery angiosome; MP, medial plantar artery angiosome; LC, lateral calcaneal artery angiosome;MC, medial calcaneal artery angiosome

Angiosomes

foot

Angiosome-guided angioplasty

DR vs IR：limb salvage at 4yrs--86% vs 69% Iida o,Nanto S,Uematsu M,et al. Importance of the angiosome concept for endovascular therapy in

patients with critical limb ischemia.Catheter Cardiovasc Interv,2010,75(6):830-836.

DR vs IR：healing rate at 2yrs--91% vs 62% Neville RF,Attinger CE, Bulan EJ,et al. Revascularization of a specific angiosome for limb salvage:

does the target artery matter? Ann Vasc Surg,2009,23(3):367-373.

DR vs IR： healing rate at 1yr--92% vs 73% Alexanderscu V,Vincent G,Azdad K,et al. A reliable approach to diabetic neuroischemic foot wounds:

below-the-knee angiosome-oriented angioplasty.J Endovasc Ther,2011,18(3):376-387.

DR： Direct revascularization

IR: Indirect revascularization

Materials

• A retrospective analysis of 102 infrapopliteal

angioplasty cases with Fontaine Ⅳ ischemia

• Male = 60, age = 72 ±11 yrs

• DR (angioplasty based on the angiosome concept) :47

IR ( angioplasty cases not based on the angiosome concept):55

Baseline of clinical characteristics

Risk factors DR(n=47) IR(n=55) P value

>70yrs 39(83%) 43(78.2%) 0.545

DM>10yrs 44(93.6%) 47(85.5%) 0.187

Coronary artery disease 35(74.5%) 40(72.7%) 0.843

Hypertension 36(76.6%) 43(78.2%) 0.849

Chronic kidney disease 4(8.5%) 6(10.9%) 0.686

End-stage renal disease

(haemodialysis)

10(21.3%) 13(23.6%) 0.696

Hyperlipidemia 41(87.2%) 49(89.1%) 0.773

Baseline of lesions

Lesion characteristics DR(n=47) IR(n=55) P value

2-3 vessels runoff involvement 44(93.6%) 51(92.7%) 0.860

occlusion>10cm 41(87.2%) 52(94.5%) 0.197

Pedal or plantar arch occlusion 26(55.3%) 27(49.1%) 0.532

Pedal tissue loss or gangrene 26(55.3%) 34(61.8%) 0.508

Plantar tissue loss or gangrene 21(44.7%) 21(38.2%) 0.508

Materials of EVT

Site of tissue loss Feeding arteries with EVT

Dorsal tissue loss（n=26）

ATA 18

PTA+PPL 5

ATA+PTA 3

Plantar tissue loss（n=21） PTA 21

DR

ATA: anterior tibial artery PTA: posterior tibial artery PPL: pedal and plantar loop

Site of tissue loss Artereis with EVT

Dorsal tissue loss（n=34）

PTA 9

Per A 12

PTA+Per A 13

Plantar tissue loss（n=21） ATA 3

Per A 8

ATA+Per A 10

IR

ATA: anterior tibial artery PTA: posterior tibial artery Per A: peroneal artery

Methods for evaluation

• Comparison of ABI

• Recording the wound healing condition

• Amputation-free survival (AFS) and

freedom from major amputation (MA)

Results

• Mean follow-up: 18±11 monthes

• 3 cases died of cadiovascular events

DR: 1 case

IR: 2 cases

Results

Pre-EVT Post-EVT

DR 0.17±0.03 0.86±0.09

IR 0.15±0.02 0.81±0.12

ABI

6 monthes 12monthes

DR 85.1%(40/47) 93.5%(44/46)

IR 60%(33/55) 77.4%(41/53)

P value 0.005 0.01

Healing rate

6 monthes 12 monthes

DR 100%(47/47) 93.5%(44/46)

IR 90.1%(50/55) 84.9%(45/53)

P value 0.035 0.078

Limb salvage rate

EVT with Agiosome

2yrs FU

EVT with Agiosome

1 month FU

6 monthes FU

Conclusions

• Infrapopliteal angioplasty based on angiosome

concept may prove beneficial in terms of better

wound healing of diabetic critical foot ischemia

and subsequent limb salvage.

• Revascularization should not be denied to patients

with indirect perfusion of the ischemic angiosome

as acceptable rates of limb salvage are obtained. *

* Kabra A, Suresh KR, Vivekanand V, et al. Outcomes of angiosome and non-angiosome

targeted revascularisation in critical lower limb ischemia. J Vasc Surg. 2013;57:44-49

Donghua Ji MD

The interventional therapy Department of the 1st Hospital of

Dalian Medical University, China