Angiosome Targeted PTA is More Important in Endovascular Revascularisation than in Surgical Revascularisation : Analysis of 545 Patients with Ischaemic Tissue Lesions

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Spillerova , K , Settembre , N , Biancari , F , Albäck , A & Venermo , M 2017 , ' Angiosome Targeted PTA is More Important in Endovascular Revascularisation than in Surgical Revascularisation : Analysis of 545 Patients with Ischaemic Tissue Lesions ' , European Journal of Vascular and Endovascular Surgery , vol. 53 , no. 4 , pp. 567-575 . https://doi.org/10.1016/j.ejvs.2017.01.008

Title: Angiosome Targeted PTA is More Important in Endovascular Revascularisation than in Surgical Revascularisation : Analysis of 545 Patients with Ischaemic Tissue Lesions
Author: Spillerova, K.; Settembre, N.; Biancari, F.; Albäck, A.; Venermo, M.
Contributor: University of Helsinki, Verisuonikirurgian yksikkö
University of Helsinki, Verisuonikirurgian yksikkö
University of Helsinki, Clinicum
Date: 2017-04
Language: eng
Number of pages: 9
Belongs to series: European Journal of Vascular and Endovascular Surgery
ISSN: 1078-5884
URI: http://hdl.handle.net/10138/236949
Abstract: Introduction: This study aimed to evaluate the impact of angiosome targeted (direct) revascularisation according to revascularisation method in patients with diabetes. Materials and methods: This retrospective study cohort comprised 545 diabetic patients with critical limb ischaemia and tissue loss (Rutherford 5, 6). All patients underwent infrapopliteal endovascular (PTA) or open surgical revascularisation between January 2008 and December 2013. Differences in the outcome after direct revascularisation, bypass surgery, and PTA were investigated by means of Cox proportional hazards analysis. The endpoints were wound healing, leg salvage, and amputation free survival. Results: Overall, 60.3% of the ischaemic wounds healed during 1 year of follow-up. The highest wound healing rate was achieved after direct bypass (77%) and the worst after indirect PTA (52%). The Cox proportional hazards analysis showed that the number of affected angiosomes = 10 mg/dL (HR 2.05, 95% CI 1.45-2.90), atrial fibrillation (HR 1.54, 95% CI 1.05-2.26), and number of affected angiosomes >3 (HR 1.75, 95% CI 1.24-2.46) were significantly associated with poor leg salvage. Direct PTA was associated with a lower rate of major amputation compared with indirect PTA (HR 0.57 95% CI 0.37-0.89). Conclusion: In diabetics, indirect endovascular revascularisation leads to significantly worse wound healing and leg salvage rates compared with direct revascularisation. Therefore, endovascular procedures should be targeted according to the angiosome concept. In bypass surgery, however, the concept is of less value and the artery with the best runoff should be selected as the outflow artery. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Subject: Angiosome
Diabetes mellitus
Wound
Infrapopliteal revascularization
CRITICAL LIMB ISCHEMIA
DIABETIC FOOT ULCERS
BYPASS-SURGERY
PEDAL ARCH
OUTCOMES
SALVAGE
METAANALYSIS
PREVALENCE
DISEASE
TRENDS
3126 Surgery, anesthesiology, intensive care, radiology
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