Abstract 4427: Acquiring Direct Flow Based on the Angiosome Concept in Endovascular Therapy Saves More Limbs Than Increasing the Number of Patent Run-off Vessels in Patients With Critical Limb Ischemia
Background: Recently, endovascular therapy (EVT) has become an attractive alternative to bypass surgery in patients with critical limbs ischemia (CLI). However, whether acquiring direct flow to the site of ulceration based on the angoisome concept is beneficial in patients with CLI undergoing EVT remains unclear although the usefulness of angiosome concept has been proven in bypass surgery. We sought to investigate whether the angiosome concept is useful in EVT in terms of limb salvage in patients with CLI.
Methods: We analyzed 203 limbs in 177 consecutive patients (male=127, age; 70±11 years) with ischemic ulceration/gangrene (Rutherford 5, 145 limbs; Rutherford 6, 58 limbs) who underwent successful EVT, but not bypass surgery. We classified the patients into direct and indirect groups depending on whether the feeding artery flow to the site of ulceration/gangrene was successfully acquired based on the angiosome concept. Freedom from amputation was compared between the groups by Kaplan-Meier analysis. Angiosome was defined as the anterior tibial artery supplies the dorsum side of first to fifth toes and the dorsum of the foot; the posterior tibial artery, the plantar side of first to fifth toes and the inside of the heel; the peroneal artery, outside of the foot.
Results: The overall limb salvage rate was 82% (167/203). Skin perfusion pressure (SPP) was significantly higher in the direct group (67±25 mmHg) than in the indirect group (41±20 mmHg, P=0.002) after EVT. The limb salvage rate was significantly (P=0.03) higher in the direct group (86%) than in the indirect group (69%) for up to 4 years after the procedure. The number of vessels with run-off flow did not influence the limb salvage rate in either the direct group (p=0.84) or the indirect group (p=0.90).
Conclusion: Acquiring direct flow based on the angiosome concept in EVT saves more limbs than increasing the number of patent run-off vessels in patients with critical limb ischemia