Angiosome-Targeted Infrapopliteal Angioplasty: Impact on Clinical Outcomes-An Observational Study

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Diabetic Limb Complications

Background:

• Angiosome concept (AC)-based revascularization efficacy is debated due to patient heterogeneity and complex vascular anatomy.
• Choke vessels and plantar arch integrity influence revascularization outcomes in chronic limb-threatening ischemia (CLTI).
• Diabetic patients with CLTI present unique challenges for limb salvage strategies.

Purpose of the Study:

• To evaluate the effectiveness of angiosome concept (AC)-guided revascularization in diabetic patients with Rutherford 5-6 CLTI.
• To compare outcomes of direct versus indirect revascularization, including wound healing and limb salvage rates.
• To assess the impact of drug-coated balloon angioplasty within the AC framework.

Main Methods:

• Retrospective analysis of 51 diabetic patients with CLTI undergoing below-the-knee angioplasty (drug-coated or plain balloon).
• Comparison of microcirculation changes between directly and indirectly revascularized angiosomes.
• Cox proportional hazards analysis for ulcer healing, limb salvage, and amputation-free survival, considering factors like angiosome number and intervention type.

Main Results:

• Direct revascularization achieved in 38 limbs; indirect in 13. Fewer than three affected angiosomes correlated with better wound healing (HR 0.49).
• Direct drug-coated balloon angioplasty showed the most favorable wound healing trends (p=0.091) compared to indirect angioplasty (p=0.206).
• At 1-year follow-up, the major amputation rate was 17.7%. Direct endovascular revascularization trended towards lower major amputation rates.

Conclusions:

• Adherence to the angiosome concept in treatment planning appears to enhance arterial ulcer healing and limb salvage rates.
• Targeted drug-coated balloon angioplasty, guided by the AC, offers promising results for diabetic CLTI, even with multiple affected angiosomes.
• Direct revascularization strategies aligned with the AC may improve clinical outcomes in complex lower limb ischemia.