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.
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San Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Local Hlth Unit Florence, Diabet Foot Ctr, Florence, ItalySan Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Troisi, Nicola
Turini, Filippo
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San Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Local Hlth Unit Florence, Diabet Foot Ctr, Florence, ItalySan Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Turini, Filippo
Chisci, Emiliano
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San Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Local Hlth Unit Florence, Diabet Foot Ctr, Florence, ItalySan Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Chisci, Emiliano
Ercolini, Leonardo
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San Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Local Hlth Unit Florence, Diabet Foot Ctr, Florence, ItalySan Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Ercolini, Leonardo
Frosini, Pierfrancesco
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San Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Local Hlth Unit Florence, Diabet Foot Ctr, Florence, ItalySan Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Frosini, Pierfrancesco
Lombardi, Renzo
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San Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Local Hlth Unit Florence, Diabet Foot Ctr, Florence, ItalySan Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Lombardi, Renzo
Falciani, Francesca
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Local Hlth Unit Florence, Diabet Foot Ctr, Florence, ItalySan Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Falciani, Francesca
Baggiore, Cristiana
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Local Hlth Unit Florence, Diabet Foot Ctr, Florence, ItalySan Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Baggiore, Cristiana
Anichini, Roberto
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Local Hlth Unit Florence, Diabet Foot Ctr, Florence, ItalySan Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Anichini, Roberto
Michelagnoli, Stefano
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San Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
Local Hlth Unit Florence, Diabet Foot Ctr, Florence, ItalySan Giovanni di Dio Hosp, Dept Surg, Vasc & Endovasc Surg Unit, Via Torregalli 3, I-50143 Florence, Italy
机构:Univ Calif San Diego, Sulpizio Cardiovasc Ctr, Div Cardiovasc Med, 9444 Med Ctr Dr,MC 7411, La Jolla, CA 92037 USA
Dominguez, Arturo, III
Bahadorani, John
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Bahadorani, John
Reeves, Ryan
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Reeves, Ryan
Mahmud, Ehtisham
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Mahmud, Ehtisham
Patel, Mitul
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Univ Calif San Diego, Sulpizio Cardiovasc Ctr, Div Cardiovasc Med, 9444 Med Ctr Dr,MC 7411, La Jolla, CA 92037 USAUniv Calif San Diego, Sulpizio Cardiovasc Ctr, Div Cardiovasc Med, 9444 Med Ctr Dr,MC 7411, La Jolla, CA 92037 USA
机构:
Harvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USAHarvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USA
Conrad, Mark F.
Crawford, Robert S.
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Harvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USAHarvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USA
Crawford, Robert S.
Hackney, Lauren A.
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Harvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USAHarvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USA
Hackney, Lauren A.
Paruchuri, Vikram
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Harvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USAHarvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USA
Paruchuri, Vikram
Abularrage, Christopher J.
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Harvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USAHarvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USA
Abularrage, Christopher J.
Patel, Virendra I.
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Harvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USAHarvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USA
Patel, Virendra I.
Lamuraglia, Glenn M.
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Harvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USAHarvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USA
Lamuraglia, Glenn M.
Cambria, Richard P.
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Harvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USAHarvard Univ, Sch Med, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA 02114 USA