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-
1.
Hirsch AT & Duval S: The global pandemic of peripheral artery disease. Lancet 382: 1312, 2013.
-
2.
Jude EB , Oyibo SO & Chalmers N et al.: Peripheral arterial disease in diabetic and nondiabetic patients. Diabetes Care 24: 1433, 2001.
-
3.
Hirsch AT , Haskal ZJ & Hertzer NR et al.: ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease): summary of recommendations. J Vasc Interv Radiol 17: 1383, 2006.
-
4.
Hirsch AT , Criqui MH & Treat-Jacobson D et al.: Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 286: 1317, 2001.
-
5.
Criqui MH , Langer RD & Fronek A et al.: Mortality over a period of ten years in patients with peripheral arterial disease. N Engl J Med 326: 381, 1992.
-
6.
Prompers L , Huijberts M & Apelqvist J et al.: High prevalence of ischemia, infection and serious comorbidity in patients with diabetic foot disease in Europe: baseline results from the Eurodiale Study. Diabetologia 50: 18, 2007.
-
7.
Shah B , Rockman CB & Guo Y et al.: Diabetes and vascular disease in different arterial territories. Diabetes Care 37: 1636, 2014.
-
8.
Selvin E , Wattanakit KW & Steffes MW et al.: HbA1c and peripheral arterial disease in diabetes: the Atherosclerosis Risk in Communities study. Diabetes Care 29: 877, 2006.
-
9.
Fiordaliso F , Clerici G & Maggioni S et al.: Prospective study on microangiopathy in type 2 diabetic foot ulcer. Diabetologia 59: 1542, 2016.
-
10.
Tesfaye S , Boulton AJM & Dickenson AH: Mechanisms and management of diabetic painful distal symmetrical polyneuropathy. Diabetes Care 36: 2456, 2013.
-
11.
Norgren L , Hiatt WR & Dormandy JA et al; TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 45: S5, 2007.
-
12.
Patel MR , Conte MS & Cutlip DE et al.: Evaluation and treatment of patients with lower extremity peripheral artery disease: consensus definitions from Peripheral Academic Research Consortium (PARC). J Am Coll Cardiol 65: 931, 2015.
-
13.
Romiti M , Albers M & Brochado-Neto FC et al.: Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg 47: 975, 2008.
-
14.
Biancari F & Juvonen T: Angiosome-targeted lower limb revascularization for ischemic foot wounds: systematic review and meta-analysis. Eur J Vasc Endovasc Surg 47: 517, 2014.
-
15.
Taylor GI & Palmer JH: The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 40: 113, 1987.
-
16.
Sodestrom M , Alback A & Biancari F et al.: Angiosome targeted infrapopliteal endovascular revascularization for treatment of diabetic foot ulcers. J Vasc Surg 57: 427, 2013.
-
17.
Van Golde JM , Ruiter MS & Schaper NC et al.: Impaired collateral recruitment and outward remodeling in experimental diabetes. Diabetes 57: 2818, 2008.
-
18.
Attinger CE , Evans KK & Bulan E et al.: Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg 117: 261S, 2006.
-
19.
Bosanquet DC , Glasbey JCD & Williams IM et al.: Systematic review and meta-analysis of direct versus indirect angiosomal revascularization of infrapopliteal arteries. Eur J Vasc Endovasc Surg 48: 88, 2014.
-
20.
Chae KJ & Shin JY: Is angiosome-targeted angioplasty effective for limb salvage and wound healing in diabetic foot? a meta-analysis. PLoS One 11: e0159523, 2016.
-
21.
Sampson MJ & Drury PL: Accurate estimation of glomerular filtration rate in diabetic nephropathy from age, body weight, and serum creatinine. Diabetes Care 15: 609, 1992.
-
22.
Piaggesi A , Castro Lòpez E & Bini L et al.: Measurable deficit of autonomic and sensory nerve function in asymptomatic diabetic patients. J Diabetes Complications 6: 157, 1992.
-
23.
Charlson M , Szatrowski TP & Peterson J et al.: Validation of a combined comorbidity index. J Clin Epidemiol 47: 1245, 1994.
-
24.
Mazzariol F , Ascher E & Salles-Cunha SX et al.: Values and limitations of duplex ultrasonography as the sole imaging method of preoperative evaluation for popliteal and infrapopliteal bypasses. Ann Vasc Surg 13: 1, 1999.
-
25.
Scatena A , Petruzzi P & Ferrari M et al.: Outcomes of three years of team work on critical limb ischemia in patients with diabetes and foot lesions. Int J Low Extrem Wounds 11: 113, 2012.
-
26.
Aiello A , Anichini R & Brocco E et al.: Treatment of peripheral arterial disease in diabetes: a consensus of the Italian Society of Diabetes (SID; AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE). Nutr Metab Cardiovasc Dis 24: 355, 2014.
-
27.
Bargellini I , Piaggesi A & Cicorelli A et al.: Predictive value of angiographic scores for the integrated management of the ischemic diabetic foot. J Vasc Surg 57: 1204, 2013.
-
28.
Toursarkissian B , D'Ayala M & Stefanidis D et al.: Angiographic scoring of vascular occlusive disease in the diabetic foot: relevance to bypass graft patency and limb salvage. J Vasc Surg 35: 494, 2002.
-
29.
Oyibo SO , Jude EB & Tarawneh I et al.: A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care 24: 84, 2001.
-
30.
Bakker K , Apelqvist J & Lipsky BA et al.: The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes development of an evidence-based global consensus. Diabetes Metab Res Rev 32: 2, 2016.
-
31.
Lipsky BA: Medical treatment of diabetic foot infections. Clin Infect Dis 39: S104, 2004.
-
32.
Prompers L , Schaper N & Apelqvist J et al.: Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia 51: 747, 2008.
-
33.
Adam DJ , Beard JD & Cleveland T et al; BASIL Trial Participants: Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 366: 1925, 2005.
-
34.
Giles KA , Pomposelli FB & Spence TL et al.: Infrapopliteal angioplasty for critical limb ischemia: relation of TransAtlantic InterSociety Consensus class to outcome in 176 limbs. J Vasc Surg 48: 128, 2008.
-
35.
Varela C , Acin F & de Haro F et al.: The role of foot collateral vessels on ulcer healing and limb salvage after successful endovascular and surgical distal procedures according to an angiosome model. Vasc Endovascular Surg 44: 654, 2010.
-
36.
Kagaya Y , Ohura N & Suga H et al.: “Real angiosome” assessment from peripheral tissue perfusion using tissue oxygen saturation foot-mapping in patients with critical limb ischemia. Eur J Vasc Endovasc Surg 47: 433, 2014.
-
37.
Chen YW , Wang YY & Zhao D et al.: High prevalence of lower extremity peripheral artery disease in type 2 diabetes patients with proliferative diabetic retinopathy. PLoS One 10: e0122022, 2015.
-
38.
Norman PE , Davis WA & Bruce DG et al.: Peripheral arterial disease and risk of cardiac death in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care 29: 575, 2006.
-
39.
Sacks D: The TransAtlantic Inter-Society Consensus (TASC) on the Management of Peripheral Arterial Disease. J Vasc Interv Radiol 14: S351, 2003.
-
40.
Faglia E , Clerici G & Losa S et al.: Limb revascularization feasibility in diabetic patients with critical limb ischemia: results from a cohort of 344 consecutive unselected diabetic patients evaluated in 2009. Diabetes Res Clin Pract 95: 364, 2012.
-
41.
Freisinger E , Koeppe J & Gerss J et al.: Mortality after use of paclitaxel-based devices in peripheral arteries: a real-world safety analysis. Eur Heart J 41: 3732, 2020.
-
42.
Ouriel K , Adelman MA & Rosenfield K et al.: Safety of paclitaxel-coated balloon angioplasty for femoropopliteal peripheral artery disease. JACC Cardiovasc Intern 12: 2515, 2019.
Effect of Direct Endovascular Revascularization Based on the Angiosome Model on Risk of Major Amputations and Life Expectancy in Type 2 Diabetic Patients with Critical Limb Ischemia and Foot Ulceration
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Background
We evaluated whether direct or indirect endovascular revascularization based on the angiosome model affects outcomes in type 2 diabetes and critical limb ischemia.
Methods
From 2010 to 2015, 603 patients with type 2 diabetes were admitted for critical limb ischemia and submitted to endovascular revascularization. Among these patients, 314 (52%) underwent direct and 123 (20%) indirect revascularization, depending on whether the flow to the artery directly feeding the site of ulceration, according to the angiosome model, was successfully acquired; 166 patients (28%) were judged unable to be revascularized. Outcomes were healing, major amputation, and mortality rates.
Results
An overall healing rate of 62.5% was observed: patients who did not receive percutaneous transluminal angioplasty presented a healing rate of 58.4% (P < .02 versus revascularized patients). A higher healing rate was observed in the direct versus the indirect group (82.4% versus 50.4%; P < .001). The major amputation rate was significantly higher in the indirect versus the direct group (9.2% versus 3.2%; P < .05). The overall mortality rate was 21.6%, and it was higher in the indirect versus the direct group (24% versus 14%; P < .05).
Conclusions
These data show that direct revascularization of arteries supplying the diabetic foot ulcer site by means of the angiosome model is associated with a higher healing rate and lower risk of amputation and death compared with the indirect procedure. These results support use of the angiosome model in type 2 diabetes with critical limb ischemia.
Diabetic Foot Section, Medicine Department, Pisa University Hospital, Pisa, Italy.
Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Pisa, Italy.
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