Concept of Angiosome Does Not Affect Limb Salvage in Infrapopliteal Angioplasty

The purpose of this study was to evaluate the importance of the "angiosome" concept in patients with critical limb ischemia treated with infrapopliteal angioplasty, analyzing limb salvage, secondary function, and survival rates between those treated with and without reference to the concept of the angiosome (groups 1 and 2, respectively).

This was a retrospective, consecutive cohort study that evaluated 95 patients with critical limb ischemia who underwent infrapopliteal angioplasty at the Division of Vascular and Endovascular Surgery, São Paulo State Public Servants' Hospital, Brazil, between January 2009 and January 2013. Of the total 92 patients (109 limbs) who underwent angioplasty, 48 (52.2%) patients were in group 1 and 44 (47.8%) patients were in group 2.

There was no difference between groups 1 and 2 in terms of the location, lesion severity, or active infection of the infrapopliteal angioplasty. However, groups 1 and 2 differed in their postoperative ankle-brachial indices, which were 0.95 ± 0.18 and 0.85 ± 0.18, respectively (P = 0.001). The estimates of limb salvage were similar in groups 1 and 2 (87% and 92.3%, respectively, at 360 days; P = 0.241). The analysis of secondary function did not differ between the 2 groups (65.1% and 58.3%, respectively, within 360 days; P = 0.92). Operative mortality was 8.3% in group 1 and 8% in group 2 (P = 0.60), and survival at 360 days was 78.5% in group 1 and 78.3% in group 2 (P = 0.86), which were not significantly different.

In this study, we found no evidence to support revascularization based on the concept of the angiosome in preference to revascularization of the artery that is most amenable to endovascular treatment for limb salvage and secondary function.