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foot angiosome

Kristýna Špillerová, Fausto Biancari, Nicla Settembre, Anders Albäck, Maarit Venermo
BACKGROUND: The definition of angiosome-targeted revascularization is confusing, especially when a tissue lesion affects several angiosomes. Two different definitions of direct revascularization exist in the literature. The study aim was: 1) to compare the two definitions of direct revascularization in patients with foot lesions involving more than one angiosome, and 2) to evaluate which definition better predicts clinical outcome. MATERIALS AND METHODS: This study cohort comprises 658 patients with Rutherford 5-6 foot lesions who underwent infrapopliteal endovascular or surgical revascularization between January 2010 and July 2013...
September 29, 2016: Annals of Vascular Surgery
Hyun Suk Suh, Tae Suk Oh, Ho Seung Lee, Seung Hwan Lee, Yong Pil Cho, Joong Ryul Park, Joon Pio Hong
BACKGROUND: Major vessels in the diabetic foot are often calcified and inadequate for use as recipient vessels. Thus, a supermicrosurgery technique using small branches or perforators from other collateral vessels with an adequate pulse may be an alternative method. This study evaluated outcome using the supermicrosurgery concept and the risk factors involved. METHODS: Ninety-five cases of diabetic foot reconstruction were reviewed; the average patient age was 57 years; average follow-up was 43...
October 2016: Plastic and Reconstructive Surgery
C Caradu, A S Battut, C Gonthier, D Midy, E Ducasse
One third of patients with critical limb ischemia (CLI) has below the knee lesions and requires a restoration of direct blood flow into the foot. However, many of these patients are ineligible for open surgery. The primary goals thus become pain relief and limb salvage over patency. The angiosome concept helps determine the target artery to treat in priority. The endovascular approach has decreased morbidity and mortality rates compared to distal bypass surgery; while subintimal retrograde, trans-collateral and loop techniques push the limits of open surgery by reopening the plantar arch, thereby improving run-off...
September 1, 2016: Journal des Maladies Vasculaires
Kum Ju Chae, Jin Yong Shin
PURPOSE: Given that the efficacy of employing angiosome-targeted angioplasty in the treatment of diabetic foot remains controversial, this study was conducted to examine its efficacy. METHODS: We performed a systematic literature review and meta-analysis using core databases, extracting the treatment modality of angiosome-targeted angioplasty as the predictor variable, and limb salvage, wound healing, and revision rate as the outcome variables. We used the Newcastle-Ottawa Scale to assess the study quality, along with the Cochrane Risk of Bias Tool...
2016: PloS One
Marie Pavé, Laurent Benadiba, Ludovic Berger, Djeloul Gouicem, Maxime Hendricks, Didier Plissonnier
PURPOSE: To evaluate the long-term clinical results of Below-the-Knee Percutaneous Transluminal Angioplasty (BTK-PTA) with or without stenting, in patients with Critical Limb Ischemia (CLI), and to determine factors affecting clinical results including the role of the angiosome concept. METHODS: All patients undergoing primary BTK-PTA from January 2007 to December 2011 were included. Primary patency, assisted patency, limb salvage, survival and wound healing were assessed using the Kaplan-Meier method...
July 14, 2016: Annals of Vascular Surgery
Kyle J Cooper, Constantino Peña, James Benenati
Critical limb ischemia is a condition that has increased in prevalence and carries a high degree of morbidity. Although endovascular therapy for treatment of patients with critical limb ischemia has undergone significant advances with improved outcomes over the past decade, these patients often have multilevel disease, and it may take weeks or months for ulceration healing. For this reason, the acceptable therapeutic end points during and immediately following revascularization remain somewhat obscure. There are multiple tools available to guide the treating vascular specialist in this regard...
June 2016: Techniques in Vascular and Interventional Radiology
Jie Zheng, David Muccigrosso, Xiaodong Zhang, Hongyu An, Andrew R Coggan, Bashir Adil, Charles F Hildebolt, Chandu Vemuri, Patrick Geraghty, Mary K Hastings, Michael J Mueller
PURPOSE: To develop a noncontrast oximetric angiosome imaging approach to assess skeletal muscle oxygenation in diabetic feet. MATERIALS AND METHODS: In four healthy and five subjects with diabetes, the feasibility of foot oximetry was examined using a 3T clinical magnetic resonance imaging (MRI) scanner. The subjects' feet were scanned at rest and during a toe-flexion isometric exercise. The oxygen extraction fraction of skeletal muscle was measured using a susceptibility-based MRI method...
October 2016: Journal of Magnetic Resonance Imaging: JMRI
Scott Kinlay
Critical limb ischemia (CLI) is a clinical syndrome of ischemic pain at rest or tissue loss, such as nonhealing ulcers or gangrene, related to peripheral artery disease. CLI has a high short-term risk of limb loss and cardiovascular events. Noninvasive or invasive angiography help determine the feasibility and approach to arterial revascularization. An endovascular-first approach is often advocated based on a lower procedural risk; however, specific patterns of disease may be best treated by open surgical revascularization...
February 2016: Circulation. Cardiovascular Interventions
Xiang-Tao Zheng, Rui-Chao Zeng, Jing-Yong Huang, Le-Men Pan, Xiang Su, Zi-Heng Wu, Guan-Feng Yu
BACKGROUND: The purpose of this study was to evaluate the clinical significance of the involvement of collateral vessels in interventional therapy based on the angiosome concept for infrapopliteal critical limb ischemia (CLI). METHODS: We enrolled 486 patients with unilateral infrapopliteal CLI (Rutherford Stage 5 or 6) treated at 2 hospitals from January 2005 to December 2014. Using the angiosome concept, the patients were categorized into 3 groups: the direct revascularization (DR) group, the indirect revascularization through collaterals (IR-tc) group, and the indirect revascularization without collaterals (IR-wc) group...
April 2016: Annals of Vascular Surgery
Kim Houlind
Critical limb ischaemia is the major cause of amputation in the developed world. When performing revascularization of the lower limb, guidelines recommend grafting of the "least diseased distal artery with the best continuous run-off to the ankle/foot... regardless of location" often implying indirect perfusion of the ischaemic area through collaterals. An alter-native strategy, called the "angiosome model", advocates a strategy which provides blood supply directly to the ischaemic area. This paper reviews the current evidence of indirect versus angiosome-directed revascularization of the lower limb...
July 27, 2015: Ugeskrift for Laeger
T Gvazava, G Smirnov, V Petrova, A Remezov, V Akimov
The aim of the study was comparative assessment of the effectiveness of typical and atypical amputations at the level of footstep in patients with the most complicated course of the diabetic foot syndrome (DFS). The patients suffering from diabetes mellitus type 2 and purulo-necrotic complications of the DFS, treated in the surgical department of the № 1 Pirogov National Surgical and Medical Center of the Sankt Petersburg Clinical Complex were investigated. The study group included 68 patients who underwent atypical surgical interventions taking into account blood flow angiosomes of footstep tissues...
March 2015: Georgian Medical News
G Torsello, S Debus, F Meyer, R T Grundmann
BACKGROUND: This overview comments on clinical trials and meta-analyses from the literature on the treatment of diabetic feet. METHODS: For the literature review, the MEDLINE database (PUBMED) was searched under the key words "diabetic foot". Publications of the last three years (2012 to 2014) were extracted. RESULTS: For patients with diabetic feet, both endovascular (ER) and open (OR) revascularisation techniques are possible. There are not sufficient data to demonstrate whether open bypass surgery or endovascular interventions are more effective in these patients...
April 2015: Zentralblatt Für Chirurgie
J-M Pernès, M Auguste, H Borie, S Kovarsky, A Bouchareb, C Despujole, G Coppé
The world is facing an epidemic of diabetes; consequently in the next years, critical limb ischemia (CLI) due to diabetic arterial disease, characterized by multiple and long occlusions of below-the-knee (BTK) vessels, will become a major issue for vascular operators. Revascularization is a key therapy in these patients as restoring adequate blood supply to the wound is essential for healing, thus avoiding major amputations. Endoluminal therapy for BTK arteries is now a key part of the vascular specialist armamentarium...
May 2015: Diagnostic and Interventional Imaging
Luis Mariano Palena, Luis Fernando Garcia, Cesare Brigato, Enrico Sultato, Alessandro Candeo, Tommaso Baccaglini, Marco Manzi
The number of diabetic patients is actually increasing all around the world, consequently, critical limb ischemia and ischemic diabetic foot disorders related to the presence of diabetic occlusive arterial disease will represent in the next few years a challenging issue for vascular specialists. Revascularization represents one step in the treatment for the multidisciplinary team, reestablishing an adequate blood flow to the wound area, essential for healing and avoiding major amputations. The targets of revascularization can be established to obtain a "complete" revascularization, treating all tibial and foot vessels or following the angiosome and wound-related artery model, obtaining direct blood flow for the wound...
September 2014: Techniques in Vascular and Interventional Radiology
Osami Kawarada, Satoshi Yasuda, Kunihiro Nishimura, Shingo Sakamoto, Miyuki Noguchi, Yasuomi Takahi, Koichiro Harada, Masaharu Ishihara, Hisao Ogawa
BACKGROUND: Benefits of 2-dimensional (2D) angiosome-oriented infrapopliteal revascularization remain controversial. The aim of this retrospective study was to clarify the effect of single tibial artery revascularization on the dorsal and plantar microcirculation of critically ischemic limbs based on skin perfusion pressure (SPP). METHODS AND RESULTS: Fifty-seven interventions that only involved either anterior tibial artery (ATA) or posterior tibial artery (PTA) revascularization were included in this study...
October 2014: Circulation. Cardiovascular Interventions
Jie Zheng, Mary K Hastings, David Muccigross, Zhaoyang Fan, Fabao Gao, John Curci, Charles F Hildebolt, Michael J Mueller
OBJECTIVE: The purpose of this study is to develop a non-contrast magnetic resonance imaging (MRI) approach to evaluate skeletal muscle perfusion in the diabetic foot based on the concept of angiosomes of the foot. METHODS: Five healthy volunteers and five participants with diabetes (HbA1c = 7.2 ± 1.8%) without a history of peripheral artery disease were examined. The non-contrast perfusion measurements were performed during a toe flexion challenge. Absolute perfusion maps were created and two regions (medial and lateral) on the maps were segmented based on angiosomes...
January 2015: European Radiology
Christopher Bibbo, David A Ehrlich, Hoang M L Nguyen, L Scott Levin, Stephen J Kovach
BACKGROUND: Historically, the lateral extensile approach for calcaneal fracture osteosynthesis has had relatively high rates of wound healing problems. The vascular territory (angiosome) of the lateral foot is now known to be dependent upon the lateral calcaneal branch of the peroneal artery (LCBP artery). We postulated that patency of the LCBP artery may have a profound positive impact on incisional wound healing for calcaneal open reduction and internal fixation (ORIF). METHODS: Ninety consecutive calcaneal fractures that met operative criteria were preoperatively evaluated for the presence of a Doppler signal in the LCBP artery and were followed for the development of wound healing problems...
July 2014: Foot & Ankle International
H Peregrina-Barreto, L A Morales-Hernandez, J J Rangel-Magdaleno, J G Avina-Cervantes, J M Ramirez-Cortes, R Morales-Caporal
Thermography is a useful tool since it provides information that may help in the diagnostic of several diseases in a noninvasive and fast way. Particularly, thermography has been applied in the study of the diabetic foot. However, most of these studies report only qualitative information making it difficult to measure significant parameters such as temperature variations. These variations are important in the analysis of the diabetic foot since they could bring knowledge, for instance, regarding ulceration risks...
2014: Computational and Mathematical Methods in Medicine
Dimitri Aerden, Nathalie Denecker, Sarah Gallala, Erik Debing, Pierre Van den Brande
Purpose. Angiosome-guided revascularization is an approach that improves wound healing but requires a surgeon to determine which angiosomes are ischemic. This process can be more difficult than anticipated because diabetic foot (DF) wounds vary greatly in quantity, morphology, and topography. This paper explores to what extent the heterogeneous presentation of DF wounds impedes development of a proper revascularization strategy. Methods. Data was retrieved from a registry of patients scheduled for below-the-knee (BTK) revascularization...
2014: International Journal of Vascular Medicine
R Forsythe, R Hinchliffe
No abstract text is available yet for this article.
May 2014: European Journal of Vascular and Endovascular Surgery
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