Angiosome Oriented or Least Diseased Vessel, Which Is the Optimal Target Arterial Path for Endovascular Revascularisation in Patients With Diabetic Foot Ulcers?

Xinhuang Hou; Shiping Ji; Pingfan Guo; Fanggang Cai; Jinchi Zhang; Yiquan Dai

doi:10.1016/j.ejvs.2023.03.008

Angiosome Oriented or Least Diseased Vessel, Which Is the Optimal Target Arterial Path for Endovascular Revascularisation in Patients With Diabetic Foot Ulcers?

Eur J Vasc Endovasc Surg. 2023 Jun;65(6):862-869. doi: 10.1016/j.ejvs.2023.03.008. Epub 2023 Mar 12.

Authors

Xinhuang Hou¹, Shiping Ji¹, Pingfan Guo¹, Fanggang Cai¹, Jinchi Zhang¹, Yiquan Dai²

Affiliations

¹ Department of Vascular Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
² Department of Vascular Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Vascular Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China. Electronic address: 403537125@qq.com.

PMID: 36918079
DOI: 10.1016/j.ejvs.2023.03.008

Abstract

Objective: The aims were to determine whether, when treating diabetic foot ulcers (1), selecting an angiosome directed (AD) vessel as the target arterial path (TAP) when candidate vessels have comparably severe disease impacts outcomes and (2) whether a more severely affected AD vessel or a less severely affected non-angiosome directed (NAD) vessel should be chosen.

Methods: This was a retrospective observational study. Patients with diabetic foot ulcers who had undergone endovascular revascularisation in the institution between January 2016 and May 2020 and had been followed up for two years were included. Eligible patients were identified retrospectively and relevant data were collected from the institution's electronic medical records. The severity of the lesions was classified using the Global Limb Anatomic Staging System (GLASS). Outcomes between various subgroups were compared according to the severity of the lesions to determine the optimal TAP choice in each case.

Results: The study cohort comprised 215 patients (216 limbs). The affected limbs were classified as follows: 93 (43.1%) as GLASS 1 - 2 AD; 27 (12.5%) as GLASS 1 - 2 NAD, 62 (28.7%) as GLASS 3 AD, and 34 (15.7%) as GLASS 3 NAD groups. In the GLASS 1 - 2 group, rates of ulcer healing, survival, and amputation free survival were higher and time to healing shorter in the AD than NAD group. In the GLASS 3 group, there were no significant differences between the AD and NAD groups for any studied outcome measures, including ulcer healing and overall survival. Using a more severely diseased AD as the TAP did not achieve significantly better outcomes than using a less severely affected NAD vessel.

Conclusion: Selecting the AD vessel may achieve better outcomes when two candidate TAPs belong to GLASS 1 - 2, whereas selecting the least diseased vessel as the TAP regardless of AD or NAD status may be preferable in other situations.

Keywords: Angiosome directed; Diabetic foot ulcers; Endovascular revascularisation; Target arterial path (TAP).

Publication types

Observational Study

MeSH terms

Diabetes Mellitus*
Diabetic Foot* / surgery
Endovascular Procedures* / adverse effects
Humans
Ischemia / surgery
Limb Salvage
NAD
Peripheral Arterial Disease* / surgery
Retrospective Studies
Risk Factors
Treatment Outcome
Vascular Surgical Procedures

Substances

NAD