Differential impact of bypass surgery and angioplasty on angiosome-targeted infrapopliteal revascularization.
OBJECTIVE
The aim of this study was to evaluate the impact of angiosome targeted revascularization according to the revascularization method.


METHODS
Retrospective observational study.


METHODS
This study cohort comprised 744 consecutive patients who underwent infrapopliteal endovascular or surgical revascularization between January 2010 and July 2013. Differences in outcomes after bypass surgery and PTA were adjusted by estimating a propensity score, which was employed for one to one matching as well as adjusted analysis.


RESULTS
Cox proportional hazards analysis showed that angiosome-targeted revascularization (HR 1.29, 95% CI 1.02-1.65), bypass surgery (HR 1.79, 95% CI 1.41-2.27), C-reactive protein ≤10 mg/dL (HR 1.42, 95% CI 1.11-1.81), and the number of affected angiosomes (HR 0.85, 95% CI 0.74-0.98) were independent predictors of improved wound healing. When adjusted for the number of affected angiosomes and C-reactive protein ≤10 mg/dL, angiosome-targeted bypass surgery was associated with a significantly higher rate of wound healing than non-angiosome-targeted angioplasty (HR 2.27, 95% CI 1.61-3.20). This was confirmed in propensity score adjusted analysis (HR 1.72, 95% CI 1.35-2.16). Among patients who underwent angiosome-targeted revascularization, the propensity score adjusted analysis showed that bypass surgery was associated with a significantly better rate of wound healing (HR 154, 95% CI 1.09-2.16) but similar limb salvage rates when compared with angioplasty (HR 0.79, 95% CI 0.44-1.43).


CONCLUSIONS
Rates of wound healing and limb salvage in patients with critical limb ischemia (CLI) were significantly better after angiosome-targeted revascularization, bypass surgery achieving significantly better wound healing than angioplasty.
Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: ext-kristyna.spillerova@hus.fi.
K
K
Spillerova
Oulu University, Oulu University Hospital, Oulu, Finland.
F
F
Biancari
Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
A
A
Leppäniemi
Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
A
A
Albäck
Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
M
M
Söderström
Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
M
M
Venermo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005528:Foot / Q000098:blood supply* / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D023821:Limb Salvage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods; D014945:Wound Healing
Angioplasty; Angiosome; Critical limb ischemia; Infrapopliteal bypass; Revascularization; Ulcer