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Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia
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Importance of the angiosome concept for endovascular therapy in patients with critical limb ischemia

Osamu Iida1, Shinsuke Nanto, Masaaki Uematsu

  • 1Cardiovascular Division, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|March 23, 2010
PubMed

Insights

Directly restoring blood flow to the ulcer site using the angiosome concept significantly improves limb salvage rates in patients undergoing endovascular therapy (EVT) for critical limb ischemia (CLI). This approach is crucial for successful EVT outcomes.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Podiatry

Background:

  • The angiosome concept is established in bypass surgery for critical limb ischemia (CLI).
  • Systematic comparison of angiosome-guided direct vs. indirect revascularization for amputation-free survival in CLI patients undergoing endovascular therapy (EVT) is lacking.
  • CLI poses a significant risk of amputation, necessitating effective treatment strategies.

Purpose of the Study:

  • To investigate the role of the angiosome concept in endovascular therapy (EVT) for limb salvage in patients with CLI.
  • To compare limb salvage rates between direct and indirect angiosome-targeted revascularization in CLI patients undergoing EVT.
  • To evaluate the impact of achieving direct flow to the ulcer site on amputation-free survival.

Main Methods:

  • Analysis of 203 limbs in 177 consecutive patients with Rutherford 5 or 6 CLI undergoing EVT alone.
  • Classification of patients into 'direct' (successful feeding artery acquisition) and 'indirect' (unsuccessful acquisition) groups based on the angiosome concept.
  • Kaplan-Meier analysis to compare freedom from amputation between the direct and indirect groups.

Main Results:

  • Overall limb salvage rate was 82%.
  • The direct group showed significantly higher skin perfusion pressure (67 mm Hg) compared to the indirect group (41 mm Hg).
  • Limb salvage rates were significantly higher in the direct group (86%) versus the indirect group (69%) up to 4 years post-EVT (P=0.03).
  • The number of run-off vessels did not influence limb salvage in either group.

Conclusions:

  • Achieving direct arterial flow to the ulceration site, guided by the angiosome concept, is critical for successful limb salvage in patients with CLI undergoing EVT.
  • Angiosome-directed EVT offers a significant advantage in preventing amputation compared to indirect revascularization strategies.
  • Targeting specific angiosomes during EVT enhances treatment efficacy for critical limb ischemia.
Abstract

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