Practice Following Angiosome Concept In Diabetic Foot And Critical Limb Ischemia:Comparison Of Outcomes

Purpose：To assess application and clinical results of angiosome concept in treatingdiabetic foot and critical lower extremity ischemia.Methods：A retrospective study reviewed82consecutive patients (42patients withdiabetic feet,40patients with CLI) who underwent infrainguinal angioplasty orangioplasty combined with stenting guided by angiosome concept from2010.01to2011.06. Perioperative management includes using antiplatelets,statins, hypoglycemicdrugs and antihypertensive drugs. Ultrasound debridement and vacuum sealingdrainage(VSD) is used to assist repairing the wound. After6-month fowllow-up wascompleted, the documented data including preoperative and postoperative ABIvalue,location of foot ulcers,distribution of culprit infrainguinal vessels, technical andclinical results were analyzed and compared using SPSS17.0.Results：There was no difference of demographical features in these two groups.Improved ABI value in DF group and CLI group were0.20±0.16,0.39±0.11at6months,respectively, p<0.001.Locations of feet ulcers did not differ between twogroups（χ2=0.143,p=0.706）,whilst the distribution of culprit vessels was differentstatistically（χ2=15.115,p=0.004）,with higher rate of involved superficial femoralarteries and popliteal arteries in CLI group（χ2=7.981,p=0.005） than in DF group（χ2=7.981,p=0.005）. The technical success rate（75%in DF group，76.19%in CLIgroup，p=0.896）, clinical success rate（70.83%in DF group，83.33%in CLI group，p=0.162）, major amputation rate（8.33%in DF group，7.14%in CLI group，p=0.833）and motality（7.14%in DF group，5.00%in CLI group，p=0.523）were notsignificantly different in these two groups. The outcomes of feet ulcers seemed to benegatively affected by higher wagner grade in DF group（Spearman correlation coefficient0.515，kendall correlation coefficient0.448）.Conclusions：There is significant difference in distribution of lower extremity culpritvessels between carefully selective patients of diabetic foot and CLI, but both thetechnical and clinical results seem no difference in these two groups. Theendovascular therapy guided by angiosome concept my prove benefical in terms ofbetter wound healing and subsequent limb salvage.Further technical improvementsand more and larger prospective randomized comparative studies are necessary tosupport these observations.