Importance of the Angiosome Concept for Endovascular Therapy in Patients with Critical Limb Ischemia

被引:155
|
作者
Iida, Osamu [2 ]
Nanto, Shinsuke [1 ]
Uematsu, Masaaki [2 ]
Ikeoka, Kuniyasu [2 ]
Okamoto, Shin [2 ]
Dohi, Tomoharu [2 ]
Fujita, Masashi [2 ]
Terashi, Hiroto [3 ]
Nagata, Seiki [2 ]
机构
[1] Osaka Univ, Grad Sch Med, Dept Adv Cardiovasc Theraput, Suita, Osaka 5650871, Japan
[2] Kansai Rosai Hosp, Div Cardiovasc, Amagasaki, Hyogo, Japan
[3] Kobe Univ, Grad Sch Med, Dept Plast Surg, Kobe, Hyogo 657, Japan
关键词
endovascular therapy; critical limbs ischemia; angiosome; limb salvage; PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY; ARTERY BYPASS; SALVAGE; FOOT; ANKLE;
D O I
10.1002/ccd.22319
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: We investigated the role of the angiosome concept in endovascular therapy (EVT) for limb salvage. Background: The angiosome concept is clinically useful in bypass surgery for critical limbs ischemia (CLI). However, comparison with direct and indirect flow to the site of ulceration based on angiosome concept regarding freedom from amputation has not been systematically studied for the patient with CLI undergoing EVT. Methods: We analyzed 203 limbs in 177 consecutive patients (male = 127, age = 70 11 years) with ischemic ulceration that was Rutherford 5 or 6 (5 in 145 limbs and 6 in 58 limbs; pretreatment ankle-brachial index = 0.74 +/- 0.27), who underwent EVT alone without bypass surgery. We classified these patients into direct and indirect groups depending on whether feeding artery flow to the site of ulceration was successfully acquired or not acquired based on the angiosome concept. Freedom from amputation was compared between the direct and the indirect groups by Kaplan-Meier analysis. Results: The overall limb salvage rate was 82% (167/203). Skin perfusion pressure was significantly higher in the direct group (67 +/- 25 mm Hg) than in the indirect group (41 +/- 20 mm Hg, P = 0.002). The limb salvage rate was also significantly (P = 0.03) higher in the direct group (86%) than in the indirect group (69%) for up to 4 years after the procedure. The number of vessels with run-off flow did not influence the limb salvage rate in either the direct group (P = 0.84) or the indirect group (P = 0.90). Conclusion: Acquiring direct flow based on the angiosome concept is important for limb salvage by EVT in patients with CLI. (C) 2010 Wiley-Liss, Inc.
引用
收藏
页码:830 / 836
页数:7
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