Infrapopliteal angioplasty using a combined angiosomal reperfusion strategy

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Endovascular Therapy

Background:

• Infra-popliteal angioplasty is common, but evidence guiding device selection and target artery for optimal reperfusion is limited.
• Direct reperfusion (DR) targets the affected tissue's artery, while indirect reperfusion (IR) targets collateral arteries.
• Combined reperfusion (CR) aims to open all tibial arteries, achieving both DR and IR.

Purpose of the Study:

• To review outcomes of combined reperfusion (CR) in infra-popliteal angioplasty.
• To compare CR outcomes with direct reperfusion (DR) or indirect reperfusion (IR) alone.
• To analyze outcomes, including wound healing, limb salvage, and survival, in patients undergoing infra-popliteal angioplasty.

Main Methods:

• Retrospective review of 250 infra-popliteal angioplasty procedures over eight years.
• Data collected included wound healing, limb salvage, amputation-free survival, overall survival, and re-intervention rates.
• Multivariate analysis was used to correct for confounders and calculate hazard ratios (HR) and odds ratios (OR).

Main Results:

• Combined reperfusion (CR) was achieved in 9% of procedures (22/250).
• CR significantly improved amputation-free survival (HR 0.504, p=0.039) and re-intervention and amputation-free survival (HR 0.414, p=0.005) compared to IR.
• Wound healing was also significantly improved with CR (OR 0.35, p=0.047), with similar effects observed in diabetic patients.

Conclusions:

• Combined revascularisation (CR) is feasible in a small percentage of infra-popliteal angioplasty cases.
• Successful CR significantly enhances wound healing and amputation-free survival compared to IR alone.
• These findings support the pursuit of CR strategies for improved patient outcomes in critical limb ischemia.