The role of foot collateral vessels on ulcer healing and limb salvage after successful endovascular and surgical distal procedures according to an angiosome model.
OBJECTIVE
Analyze the influence of the collateral distal vessels on ischemic ulcer healing and limb salvage after successful distal procedures, according to an angiosome model.


METHODS
Retrospective analysis of 76 ischemic ulcers revascularized by surgical (n = 41) and endovascular (n = 35) distal procedures. All interventions were primary procedures with single outflow vessel that remained patent during follow-up. Ulcers were classified according to an angiography angiosome study as ''direct revascularization'' ([DR] n = 45), ''indirect revascularization'' ([IR] n = 31), and IR ''through collaterals'' ([IRc] n = 18). Healing rates and limb salvage were compared according to the type of revascularization.


RESULTS
Ulcer healing rate at 12 months was higher in DR than in IR (92% vs 73%, P = .008) but similar to IRc (92% vs 85%). Limb salvage at 24 months was higher in DR than in IR (93% vs 72%, P = .02) but similar to IRc (93% vs 88%).


CONCLUSIONS
Ulcer blood flow restoration through collateral vessels may give similar results to those obtained through its specific source artery.
Varela
César
C
Department of Angiology and Vascular Surgery, Hospital Universitario de Getafe, Madrid, Spain. Varelot@hotmail.com
Acín
Francisco
F
de Haro
Joaquín
J
Bleda
Silvia
S
Esparza
Leticia
L
March
José Ramón
JR
D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016009:Chi-Square Distribution; D003097:Collateral Circulation; D016638:Critical Illness; D057510:Endovascular Procedures; D005260:Female; D005528:Foot / Q000098:blood supply*; D016523:Foot Ulcer / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D011859:Radiography; D012039:Regional Blood Flow; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014945:Wound Healing