Revascularization of a specific angiosome for limb salvage: does the target artery matter?

Abstract

Background: To compare clinical outcomes and technical success when direct versus indirect revascularization was achieved after endovascular technique for critical limb ischemia patients with isolated below-the-knee lesions. Fifty patients were included, 34 male and 16 female, their age from 49 to 77 years (mean 63 ±16). All patients were subjected to infra-genicular angioplasty and divided into direct 28 (31 limbs) and indirect groups 22 (24 limbs). Antegrade approach through ipsilateral CFA was used in 48 patients, while retrograde approach through tibiopedal access was used in 2 patients. Diagnostic angiography was done for all cases and duplex ultrasound was used for follow-up. Results: One hundred thirty-two lesions were encountered, 46 in the ATA, 43 in PTA, 29 in peroneal artery, and 19 in dorsalis pedis artery. Transluminal approach was done in 47 limbs while subintimal cross was used in 8 limbs. After 1 year follow-up, AFS was 75% in the direct group and 67% in the indirect group. Freedom from MALE was 65% in the direct group and 55% in the indirect group. Freedom from MA was 86% in the direct group and 75% in the indirect group. Conclusion: When there is a choice of target artery for revascularization, preference should be given to the artery directly feeding the wound’s angiosome.