Angiosome Oriented or Least Diseased Vessel, Which Is the Optimal Target Arterial Path for Endovascular
Xinhuang Hou1, Shiping Ji1, Pingfan Guo1
1Department of Vascular Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
Insights
Choosing an angiosome-directed (AD) vessel for diabetic foot ulcer treatment improved outcomes in less severe cases (GLASS 1-2). For more severe disease (GLASS 3), selecting the least diseased vessel, regardless of angiosome direction, is preferable.
Area of Science:
- Vascular Surgery
- Diabetic Limb Salvage
- Endovascular Interventions
Background:
- Diabetic foot ulcers (DFUs) represent a significant cause of morbidity and limb loss.
- Optimal selection of target arterial pathways (TAP) for endovascular revascularization in DFUs remains a critical clinical question.
Purpose of the Study:
- To evaluate the impact of angiosome-directed (AD) versus non-angiosome-directed (NAD) arterial revascularization on DFU treatment outcomes.
- To determine whether selecting a more severely diseased AD vessel or a less severely diseased NAD vessel yields better results.
Main Methods:
- Retrospective observational study of 215 patients with DFUs undergoing endovascular revascularization (2016-2020).
- Lesion severity classified using the Global Limb Anatomic Staging System (GLASS).
- Comparison of outcomes (ulcer healing, survival, amputation-free survival) between AD and NAD TAPs across different GLASS severity groups.
Main Results:
- In the GLASS 1-2 group, AD selection was associated with higher rates of ulcer healing, survival, and amputation-free survival, and shorter healing times compared to NAD.
- In the GLASS 3 group, no significant differences in outcomes were observed between AD and NAD TAPs.
- Utilizing a more severely diseased AD TAP did not yield significantly better outcomes than a less severely affected NAD TAP.
Conclusions:
- Angiosome-directed revascularization may be beneficial for diabetic foot ulcers with less severe limb disease (GLASS 1-2).
- For more severe limb disease (GLASS 3), selecting the least diseased vessel as the TAP, irrespective of angiosome direction, appears to be a preferable strategy.
Objective:
The aims were to determine whether, when treating diabetic foot ulcers (1), selecting an angiosome directed (AD) vessel as the target arterial path (TAP) when candidate vessels have comparably severe disease impacts outcomes and (2) whether a more severely affected AD vessel or a less severely affected non-angiosome directed (NAD) vessel should be chosen.
Methods:
This was a retrospective observational study. Patients with diabetic foot ulcers who had undergone endovascular revascularisation in the institution between January 2016 and May 2020 and had been followed up for two years were included. Eligible patients were identified retrospectively and relevant data were collected from the institution's electronic medical records. The severity of the lesions was classified using the Global Limb Anatomic Staging System (GLASS). Outcomes between various subgroups were compared according to the severity of the lesions to determine the optimal TAP choice in each case.
Results:
The study cohort comprised 215 patients (216 limbs). The affected limbs were classified as follows: 93 (43.1%) as GLASS 1 - 2 AD; 27 (12.5%) as GLASS 1 - 2 NAD, 62 (28.7%) as GLASS 3 AD, and 34 (15.7%) as GLASS 3 NAD groups. In the GLASS 1 - 2 group, rates of ulcer healing, survival, and amputation free survival were higher and time to healing shorter in the AD than NAD group. In the GLASS 3 group, there were no significant differences between the AD and NAD groups for any studied outcome measures, including ulcer healing and overall survival. Using a more severely diseased AD as the TAP did not achieve significantly better outcomes than using a less severely affected NAD vessel.
Conclusion:
Selecting the AD vessel may achieve better outcomes when two candidate TAPs belong to GLASS 1 - 2, whereas selecting the least diseased vessel as the TAP regardless of AD or NAD status may be preferable in other situations.
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