title: A reliable approach to diabetic neuroischemic foot wounds: below-the-knee angiosome-oriented angioplasty.
abstract: OBJECTIVE
  To evaluate the clinical benefit in wound healing and limb preservation after primary below-the-knee angioplasty guided by an angiosome model of perfusion in diabetic patients with neuroischemic foot ulcers.
  
  
  METHODS
  From September 2001 to April 2010, 232 limb-threatening neuroischemic wounds in 208 diabetic patients (147 men; mean age 74.3 years, range 42-97) were treated by below-the-knee endoluminal and/or subintimal angioplasty. There were 19 (8%) TASC II type B, 80 (34%) type C, and 133 (57%) type D infrapopliteal lesions. Patients treated prior to 2005 when the angiosome-targeted revascularization protocol was introduced (89 limbs, group 1) were compared to 134 limbs treated subsequently according to the angiosome model (group 2). The angiosome-oriented group 2 included 25% procedures focusing on the anterior tibial and dorsalis pedis arteries, 68% on the posterior tibial and plantar vessels, and 7% on the peroneal arteries.
  
  
  RESULTS
  The global technical success was 80% (187/232): 82% in group 1 and 79% in group 2. The cumulative patient survival rates were 90%, 78%, and 65% in group 1 and 93%, 82%, and 71% in group 2 at 12, 24, and 36 months, respectively (p = 0.545). At the same time points, the freedom from amputation rates were 84%, 79%, and 79% in group 1 versus 90%, 89%, and 89% in group 2 (p = 0.035). Clinical success rates were 76%, 68%, 68% in the group 1 and 85%, 79%, and 79% in group 2 (p = 0.025). Primary and secondary patency rates did not differ between groups (p = 0.813 and p = 0.511). Patients in group 2 treated with angiosome-targeted revascularization had significantly better wound healing (p<0.018) and limb preservation (p<0.030).
  
  
  CONCLUSIONS
  Below-the-knee first-line angioplasty guided by an angiosome model may prove beneficial in terms of better wound healing of diabetic foot ulcers and subsequent limb salvage. Further technical improvements and large comparative studies are necessary to support these observations.
authors.affiliation: Department of Vascular Surgery, Princesse Paola Hospital, Marche-en-Famenne, Belgium. v.alex@skynet.be
authors.forename: Vlad
authors.initials: V
authors.lastname: Alexandrescu
authors.forename: Gaetane
authors.initials: G
authors.lastname: Vincent
authors.forename: Khalid
authors.initials: K
authors.lastname: Azdad
authors.forename: Gerard
authors.initials: G
authors.lastname: Hubermont
authors.forename: Gilles
authors.initials: G
authors.lastname: Ledent
authors.forename: Christian
authors.initials: C
authors.lastname: Ngongang
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Filimon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D001530:Belgium; D017719:Diabetic Foot / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014945:Wound Healing