Is Angiosome-Guided Endovascular Therapy Worthwhile?
Yosuke Hata1, Osamu Iida1, Toshiaki Mano1
1Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
Insights
Angiosome-guided endovascular therapy (EVT) for critical limb ischemia (CLI) shows promise for wound healing, though its impact on survival needs further investigation. Future research should focus on patient and lesion factors influencing wound healing outcomes.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Endovascular therapy (EVT) is crucial for treating critical limb ischemia (CLI).
- Current guidelines recommend considering the angiosome concept for infrapopliteal revascularization in CLI patients.
- Existing literature presents mixed results regarding angiosome-guided EVT.
Purpose of the Study:
- To evaluate the effectiveness of angiosome-guided EVT in CLI treatment.
- To compare wound healing (WH) and survival outcomes of angiosome-guided EVT.
- To explore the potential of indirect revascularization within the angiosome concept.
Main Methods:
- Review of previous reports on angiosome-guided EVT for CLI.
- Analysis of wound healing, amputation-free survival, and overall survival data.
- Comparison of direct versus indirect revascularization outcomes based on the angiosome concept.
Main Results:
- Angiosome-guided EVT appears to favor wound healing over survival benefits.
- Indirect revascularization, guided by the angiosome concept and good collaterals, may yield comparable wound healing to direct revascularization.
- The overall impact on amputation-free and overall survival requires further clarification.
Conclusions:
- While angiosome-guided EVT shows potential for improving wound healing in CLI, its effect on survival remains less clear.
- Indirect revascularization within the angiosome framework can be effective for wound healing.
- Future research should identify patient and lesion characteristics influencing wound healing after angiosome-guided EVT for optimized clinical application.
Abstract:
Endovascular therapy (EVT) plays a major role in the treatment of critical limb ischemia (CLI). The latest guidelines state that the angiosome concept should be considered when performing revascularization of infrapopliteal lesions in patients with CLI. There have been several reports both of favorable and unfavorable results of angiosome-guided EVT. Based on previous reports, angiosome-guided EVT tends to improve wound healing (WH) rather than amputation-free survival and overall survival. In addition, indirect revascularization based on the angiosome concept with a good collateral flow may achieve good WH comparable to that achieved by direct revascularization. In the future, rather than just debating the effectiveness/ineffectiveness of the angiosome concept, it will be desirable to investigate the patient and lesion characteristics that may have significant influences on WH after angiosome-guided EVT and to apply the results to clinical practice.
