Angiosome-guided Endovascular Revascularization For Treatment Of Diabetic Foot Ulcers With Peripheral Artery Disease

Objective:To assess the clinical efficacy of endovascular angiosome-guided revascularization in diabetic foot ulcer patients with peripheral arterial disease.Methods:Between January 2018 and July 2019,a total of 72 consecutive legs with diabetic foot ulcers in 71 patients who were discharged from the vascular surgery department of our hospital were retrospectively evaluated.Patients’characteristics（age,gender,body fat index,left/right whether diabetes foot,smoking,drinking）,comorbidities（hypertension,cardiovascular and cerebrovascularevents）,experimentaltests（LDL,creatinine,triglycerides,glycated hemoglobin）,limb conditions（wound and infection）,hemodynamic assessment（ABI,Tc Po₂）,the details of DSA,and debridement were reviewed.A follow-up telephone call one year after discharge was carried out on each patient’s family.Comparisions of the prognosis（wound healing rate,major amputation rate,survival rate,major amputation-free survival rate）between angiosome DR and angiosome IR were performed.A propensity score match was used for the adjustment of differences in pretreatment covariables.Results:Over one year,the overall patients’survival rate was76.4%,wound healing rate was 52.8%,amputation rate was 20.6%,major amputation-free survival rate was 69%,the mean time to wound healing was 5.53±3.62 months.The wound healing rate（65.3%vs 26.1%,P<0.01）,the major survival rate（89.8%vs 47.8%,P<0.01）and the major amputation-free survival rate（77.6%vs 50.0%,P=0.02）were significant higher in the DR group than in IR group.Comparing with IR,undergoing DR could not significantly reduce the amputations rate（DR group19.1%vs IR group 25.0%,P=0.61）and the mean time to wound healing（DR group5.2±3.45months,IR group 7.1±4.40months,P=0.23）.In multivariate models,DR remained a significant predictor for wound healing（HR,7.79;95%confidence interval,2.11-28.81,P=<0.01）.Compared with restoring only one infrapopliteal artery,opening multi infrapopliteal arteries in DR group could not improve the survival rate（P=0.82）,the major amputation rate（P=0.72）,and the wound healing rate（P=0.32）.When adjusted for propensity score,the DR group still had significantly better ulcer healing rate（66.7%vs 28.6%,P=0.01）,survival rate（85.0%vs 52.0%,P=0.02）and major amputation-free survival rate（80%vs 52.0%,P=0.05）than IR group.Conclusions:Attaining a direct arterial flow based on the angiosome model of perfusion to the foot ulcer is important for ulcer healing,survival,major amputation free survival in diabetic foot patients.