Comparison of the endovascular revascularization outcomes of Anterior Tibial versus Posterior Tibial angioplasty
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 11, Pages 5405-5414
Abstract
Objective: Due to the long healing period of diabetic foot ulcers, approaches are required to recognize ways to accelerate the ulcer process of healing. The concept of the angiosome divides the body into three-dimensional tissue blocks supplied by particular source arteries. The objective of this research was to assess the value of endovascular infra-popliteal revascularization in patients with single vessel runoff taking in consideration the angiosome model of perfusion in the healing process of diabetic foot ulcers.Methods: In total, 106 patients with critical limb ischemia and single vessel runoff who had undergone endovascular revascularization were evaluated. Patient records and periprocedural leg angiograms have been reviewed. The legs were divided into two groups posterior tibial artery and anterior tibial artery single runoff , they were also divided into two groups as per to whether or not direct arterial flow to the foot ulcer site was achieved depending on the concept of angiosome (direct group) or not (indirect group). Patency rates and limb salvage rates were compared between the two groups.
Results: Our results show that PTA as a single runoff showed significantly higher primary patency (p value= 0.04) and limb salvage rates (p value= 0.01) at 3 and 6 months than the ATA as single runoff vessel. Direct flow to the angiosome going to feed ulcer region has been achieved in (51%)of patients compared with indirect revascularization in (49%) of patients. Patients treated with angiosome-targeted angioplasty had better limb salvage rates. DR limb salvage was (98%) while IR was(92%) at 6 months.(P value = 0.04)
Conclusions: Posterior tibial artery shows better limb salvage rates as a single vessel runoff and as well, direct revascularization shows better limb salvage rates than indirect revascularization
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