The Prognostic Significance of Different Definitions for Angiosome-Targeted Lower Limb Revascularization.
BACKGROUND
The definition of angiosome-targeted revascularization is confusing, especially when a tissue lesion affects several angiosomes. Two different definitions of direct revascularization exist in the literature. The study aim was (1) to compare the 2 definitions of direct revascularization in patients with foot lesions involving more than one angiosome and (2) to evaluate which definition better predicts clinical outcome.


METHODS
This study cohort comprises 658 patients with Rutherford 5-6 foot lesions who underwent infrapopliteal endovascular or surgical revascularization between January 2010 and July 2013. We compared the 2 angiosome-targeted definitions using multivariate analysis; the impact of each angiosome-targeted definition was adjusted for a propensity score obtained by means of nonparsimonious logistic regression.


RESULTS
Direct revascularization according to definition A was performed in 367 cases (55.8%) versus 198 cases (30.1%) with definition B. The propensity-score-adjusted analysis showed that definition A of direct revascularization was associated with significantly better wound healing (P < 0.044, hazard ratio [HR] 1.291) and lower amputation rates (P < 0.047, HR 0.706), whereas definition B was associated only with significantly better wound healing (P < 0.029, HR 1.321). The prognostic ability of direct revascularization according to definition A was confirmed in a Cox proportional hazard analysis.


CONCLUSIONS
Definition A of direct revascularization was associated with a significantly higher wound healing and leg salvage rate than indirect revascularization in both series. Therefore, it seems that, if the wound spreads over several angiosomes in the forefoot or heel, any angiosome involved in the wound can be targeted.
Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: kspillerova@gmail.com.
Kristýna
K
Špillerová
Department of Surgery, Oulu University Hospital, Oulu, Finland.
Fausto
F
Biancari
Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Nicla
N
Settembre
Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Anders
A
Albäck
Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Maarit
M
Venermo
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005528:Foot / Q000098:blood supply*; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D057216:Propensity Score; D016016:Proportional Hazards Models; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014945:Wound Healing