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 treating diabetic foot and critical lower extremity ischemia.Methods:A retrospective study reviewed 82 consecutive patients(42 patients withdiabetic feet,40 patients with CLI)who underwent infrainguinal angioplasty or angioplasty combined with stenting guided by angiosome concept from 2015.01 to 2016.06.Perioperative management includes using antiplatelets,statins,hypoglycemic drugs and antihypertensive drugs.Ultrasound debridement and vacuum sealing drainage(VSD)is used to assist repairing the wound.After 6-month fowllow-up was completed,the documented data including preoperative and postoperative ABI value,location of foot ulcers,distribution of culprit infrainguinal vessels,technical and clinical results were analyzed and compared using SPSS 17.0.Results:There was no difference of demographical features in these two groups.Improved ABI value in DF group and CLI group were 0.20 ± 0.16.0.39 ± 0.11 at 6 months,respectively,p<0.001.Locations of feet ulcers did not differ between two groups(χ2=0.143,p=0.706),whilst the distribution of culprit vessels was different statistically(χ2=15.115,p=0.004),with higher rate of involved superficial femoral arteries 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 CLI group,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 not significantly different in these two groups.The outcomes of feet ulcers seemed to benegatively affected by higher wagner grade in DF group(Spearman correlation coefficient 0.515,kendall correlation coefficient 0.448).Conclusions:There is significant difference in distribution of lower extremity culprit vessels between carefully selective patients of diabetic foot and CLI,but both the technical and clinical results seem no difference in these two groups.The endovascular therapy guided by angiosome concept my prove benefical in terms of better wound healing and subsequent limb salvage.Further technical improvements and more and larger prospective randomized comparative studies are necessary to support these observations.