title: Angiosome-targeted infrapopliteal endovascular revascularization for treatment of diabetic foot ulcers.
abstract: OBJECTIVE
  Because of the prolonged healing time of diabetic foot ulcers, methods for identifying ways to expedite the ulcer healing process are needed. The angiosome concept delineates the body into three-dimensional blocks of tissue fed by specific source arteries. The aim of this study was to evaluate the benefit of infrapopliteal endovascular revascularization guided by an angiosome model of perfusion in the healing process of diabetic foot ulcers.
  
  
  METHODS
  A total of 250 consecutive legs with diabetic foot ulcers in 226 patients who had undergone infrapopliteal endovascular revascularization in a single center were evaluated. Patient records and periprocedural leg angiograms were reviewed. The legs were divided into two groups depending on whether direct arterial flow to the site of the foot ulcer based on the angiosome concept was achieved (direct group) or not achieved (indirect group). Ulcer healing time was compared between the two groups. A propensity score was used for adjustment of differences in pretreatment covariables in multivariate analysis and for 1:1 matching.
  
  
  RESULTS
  Direct flow to the angiosome feeding the ulcer area was achieved in 121 legs (48%) compared with indirect revascularization in 129 legs. Foot ulcers treated with angiosome-targeted infrapopliteal percutaneous transluminal angioplasty healed better. The ulcer healing rate was mean (standard deviation) 72% (5%) at 12 months for the direct group compared with 45% (6%) for the indirect group (P < .001). When adjusted for propensity score, the direct group still had a significantly better ulcer healing rate than the indirect group (hazard ratio, 1.97; 95% confidence interval, 1.34-2.90; P = .001).
  
  
  CONCLUSIONS
  Attaining a direct arterial flow based on the angiosome model of perfusion to the foot ulcer appears to be important for ulcer healing in diabetic patients.
authors.affiliation: Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. maria.soderstrom@hus.fi
authors.forename: Maria
authors.initials: M
authors.lastname: Söderström
authors.forename: Anders
authors.initials: A
authors.lastname: Albäck
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Kimmo
authors.initials: K
authors.lastname: Lappalainen
authors.forename: Mauri
authors.initials: M
authors.lastname: Lepäntalo
authors.forename: Maarit
authors.initials: M
authors.lastname: Venermo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000401:mortality; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003646:Debridement; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005387:Finland; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054843:Negative-Pressure Wound Therapy; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011859:Radiography; D012039:Regional Blood Flow; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016038:Skin Transplantation; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000890:Anti-Infective Agents