Abstract

Aim: The purpose of this study is to assess the effectiveness of collateral circulation, which is guided by an angiosome model of perfusion, in the healing process of diabetic foot ulcers. It also evaluates the effects of direct and indirect endovascular revascularization of isolated infrapopliteal occlusive disease on wound healing and limb salvage rates.
Material and Methods: In this prospective, non-randomized, comparative clinical investigation, 42 patients who presented with isolated infrapopliteal illness with a patent ilio-femoral arterial segment for endovascular treatment of one or more tibial arteries with a Rutherford classification of 5–6 were included. Revascularization of the limb's source artery was performed on 21 direct group members, and revascularization of the arteries other than the angiosomal artery was performed on 21 indirect group members.
Results: The demographic information, Rutherford classifications, number, site, duration (months), foot ulcer size, diseased artery, and investigations before and after the treatment did not significantly differ across groups; however, the ABI did. The rates of healing at the 1-month and 3-month follow-up, major and minor amputation, chronic wounds, and death did not differ significantly across groups. Nonetheless, limb salvage and healing at the 6-month and 12-month follow-up showed a significant difference P≤0.05). The direct group had an amputation-free survival rate of 10.2 months, while the indirect group had an amputation-free survival rate of 8.8 months.
Conclusion: Chronic limb-threatening ischemia can be effectively treated with angiosome-oriented primary targeted infrapopliteal percutaneous transluminal angioplasty. To increase the chances of limb salvage in situations where the target artery's angioplastic outcomes are insufficient, infrapopliteal percutaneous transluminal angioplasty of the non-target artery should be tried.

Key words: Angiosome, targeted ip-pta, non-targeted ip-pta, healing, limb salvage, diabetic foot ulcers