title: Angiosome-targeted revascularisation in diabetic foot ulcers.
abstract: Peripheral vascular disease is a common complication of type 2 diabetes and is often more severe and diffuse than in non-diabetic individuals with a higher risk of major amputations in the lower limbs. Diabetic foot revascularisation using both traditional bypass surgery and endovascular therapy are often burdened by the failure and the inevitable subsequent massive amputation. In this study, we examined the clinical response of diabetic patients with critical limb ischaemia and extended ischaemic wounds, treated with a new angiosome-based revascularisation technique. In a 3-year period, nine diabetic patients with imminent amputation threatening and foot ulcers with no feasible arterial revascularisation options were treated by the angiosome-based surgical technique by means of deep vein arterialisation. The postoperative tcPO2 evaluation showed a mean increase in the cutaneous oxygen tension in all patients treated. The overall survival rates were 88·88%, 88·88% and 77·77% at 12, 24 and 36 months, respectively. Limb salvage was 100% at 1 year and steady at 88·88% thereafter. Surgical deep venous arterialisation might be considered as an extreme alternative to attempt tissue preservation in limbs unfit for conventional arterial revascularisations. This technique would give advantages to the patients in terms of better compliance to the minor amputations and thus avoiding major limb amputations.
authors.affiliation: Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Serra
authors.affiliation: Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Grande
authors.affiliation: Unit of Vascular and Endovascular Surgery, Regional Hospital of Cosenza, Catanzaro, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Scarcello
authors.affiliation: Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Buffone
authors.affiliation: Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: de Franciscis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D019917:Blood Vessel Prosthesis Implantation; D015331:Cohort Studies; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014680:Veins / Q000601:surgery
keywords: Angiosome; Deep veins; Diabetic foot ulcers; Revascularisation