title: Effect of single tibial artery revascularization on microcirculation in the setting of critical limb ischemia.
abstract: BACKGROUND
  Benefits of 2-dimensional (2D) angiosome-oriented infrapopliteal revascularization remain controversial. The aim of this retrospective study was to clarify the effect of single tibial artery revascularization on the dorsal and plantar microcirculation of critically ischemic limbs based on skin perfusion pressure (SPP).
  
  
  RESULTS
  Fifty-seven interventions that only involved either anterior tibial artery (ATA) or posterior tibial artery (PTA) revascularization were included in this study. SPP was measured on the dorsal side (theoretically ATA perfusion area) and the plantar side (theoretically PTA perfusion area) before and after the procedure. Dorsal and plantar SPP increased significantly, from 33 (IQR 23-40.5) to 52 (IQR 32.5-65) mm Hg (P<0.0001) and 31.6±16.1 to 44.8±19.2 mm Hg (P=0.001) after ATA revascularization, respectively, and from 29.3±14.0 to 42.4±19.7 mm Hg (P=0.003) and 29.3±9.8 to 43.5±15.9 mm Hg (P<0.001) after PTA revascularization, respectively. Both ATA and PTA revascularization were not associated with any significant differences in ΔSPP between the dorsal and the plantar regions of the foot. Only 64% and 58% of ATA revascularization cases showed higher post-SPP and ΔSPP on the dorsal side than on the plantar side, respectively. Also, only 47% and 40% of PTA revascularization cases showed higher post-SPP and ΔSPP on the plantar side than on the dorsal side, respectively.
  
  
  CONCLUSIONS
  Single tibial artery revascularization, whether of the ATA or PTA, yielded comparable improvements in microcirculation of the dorsal and plantar foot. Approximately half of the feet revascularized had a change in microcirculation that was not consistent with the 2D angiosome theory.
authors.affiliation: From the Departments of Cardiovascular Medicine (O.K., S.Y., S.S., K.H., M.I., H.O.) and Preventive Medicine and Epidemiological Informatics (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine (O.K., S.Y., M.I.) and Department of Cardiovascular Medicine (H.O.), Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and Department of Cardiovascular Medicine, Nishinokyo Hospital, Nara, Japan (M.N., Y.T.). kawarada.osami.hp@ncvc.go.jp.
authors.forename: Osami
authors.initials: O
authors.lastname: Kawarada
authors.affiliation: From the Departments of Cardiovascular Medicine (O.K., S.Y., S.S., K.H., M.I., H.O.) and Preventive Medicine and Epidemiological Informatics (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine (O.K., S.Y., M.I.) and Department of Cardiovascular Medicine (H.O.), Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and Department of Cardiovascular Medicine, Nishinokyo Hospital, Nara, Japan (M.N., Y.T.).
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.affiliation: From the Departments of Cardiovascular Medicine (O.K., S.Y., S.S., K.H., M.I., H.O.) and Preventive Medicine and Epidemiological Informatics (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine (O.K., S.Y., M.I.) and Department of Cardiovascular Medicine (H.O.), Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and Department of Cardiovascular Medicine, Nishinokyo Hospital, Nara, Japan (M.N., Y.T.).
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: From the Departments of Cardiovascular Medicine (O.K., S.Y., S.S., K.H., M.I., H.O.) and Preventive Medicine and Epidemiological Informatics (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine (O.K., S.Y., M.I.) and Department of Cardiovascular Medicine (H.O.), Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and Department of Cardiovascular Medicine, Nishinokyo Hospital, Nara, Japan (M.N., Y.T.).
authors.forename: Shingo
authors.initials: S
authors.lastname: Sakamoto
authors.affiliation: From the Departments of Cardiovascular Medicine (O.K., S.Y., S.S., K.H., M.I., H.O.) and Preventive Medicine and Epidemiological Informatics (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine (O.K., S.Y., M.I.) and Department of Cardiovascular Medicine (H.O.), Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and Department of Cardiovascular Medicine, Nishinokyo Hospital, Nara, Japan (M.N., Y.T.).
authors.forename: Miyuki
authors.initials: M
authors.lastname: Noguchi
authors.affiliation: From the Departments of Cardiovascular Medicine (O.K., S.Y., S.S., K.H., M.I., H.O.) and Preventive Medicine and Epidemiological Informatics (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine (O.K., S.Y., M.I.) and Department of Cardiovascular Medicine (H.O.), Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and Department of Cardiovascular Medicine, Nishinokyo Hospital, Nara, Japan (M.N., Y.T.).
authors.forename: Yasuomi
authors.initials: Y
authors.lastname: Takahi
authors.affiliation: From the Departments of Cardiovascular Medicine (O.K., S.Y., S.S., K.H., M.I., H.O.) and Preventive Medicine and Epidemiological Informatics (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine (O.K., S.Y., M.I.) and Department of Cardiovascular Medicine (H.O.), Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and Department of Cardiovascular Medicine, Nishinokyo Hospital, Nara, Japan (M.N., Y.T.).
authors.forename: Koichiro
authors.initials: K
authors.lastname: Harada
authors.affiliation: From the Departments of Cardiovascular Medicine (O.K., S.Y., S.S., K.H., M.I., H.O.) and Preventive Medicine and Epidemiological Informatics (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine (O.K., S.Y., M.I.) and Department of Cardiovascular Medicine (H.O.), Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and Department of Cardiovascular Medicine, Nishinokyo Hospital, Nara, Japan (M.N., Y.T.).
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.affiliation: From the Departments of Cardiovascular Medicine (O.K., S.Y., S.S., K.H., M.I., H.O.) and Preventive Medicine and Epidemiological Informatics (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine (O.K., S.Y., M.I.) and Department of Cardiovascular Medicine (H.O.), Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and Department of Cardiovascular Medicine, Nishinokyo Hospital, Nara, Japan (M.N., Y.T.).
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D003422:Critical Care; D005260:Female; D005528:Foot / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008833:Microcirculation; D055420:Perfusion Imaging; D012039:Regional Blood Flow; D012189:Retrospective Studies; D016909:Tibial Arteries / Q000601:surgery*; D014656:Vascular Surgical Procedures
keywords: angioplasty; angiosome; microcirculation; peripheral arterial disease; reperfusion