The angiosome concept in revascularization of the shin and foot arteries in patients with diabetes mellitus

Keywords: ischemia; diabetes mellitus; revascularization; roentgen-endovascular interventions; the angiosome concept; purulent-necrotic affections of foot.

Abstract

Objective. To analyze the results of revascularization of the shin and foot arteries in patients with diabetes mellitus in accordance to the angiosome concept.

Materials and methods. Results of roentgen-endovascular interventions on 71 lower extremities, performed in 48 patients, suffering diabetes mellitus and ischemia, menaced for the extremity loss, were analyzed. All the patients had purulent-necrotic affections of the foot Degree III-IV in accordance to classification of WIFI (Wound, Ishemia and Foot Infection). In accordance to anatomic zones of revascularization all roentgen-endovascular interventions were divided into three groups: Group I - 24 (33.8%) direct angiosomic revascularizations, Group II - 38 (53.5%) indirect angiosomic revascularizations, Group III - 9 (12.7%) nonangiosomic revascularizations.

Results. There was established, that following the angiosome concept raises possibility of preservation of the lower extremity (92.9%) comparing with nonangiosomic revascularization (77.8%).

Conclusion. Efficacy of revascularization of the shin arteries with occlusion-stenotic lesions is significantly higher while restoration of the blood flow in accordance to the angiosome concept.

Author Biographies

Yu. M. Gupalo, Scientific-Practical Centre of Prophylactic and Clinical Medicine, Kyiv

Gupalo Y., MD, PhD, Leading Researcher, Vascular surgeon
Research and Practical Centre of Preventive and Clinical Medicine, Kyiv, Ukraine
Email: uriy_gupalo@ukr.net
ORCID id:0000-0002-9467-115Х

D. Yu. Shapovalov, Scientific-Practical Centre of Prophylactic and Clinical Medicine, Kyiv

Shapovalov D., MD, Vascular surgeon, Junior Researcher
Research and Practical Center of Preventive and Clinical Medicine, Kyiv, Ukraine
Email: pandanila.kiev@gmail.com
ORCID id:0000-0001-7419-9559

V. V. Shaprynskyi, Scientific-Practical Centre of Prophylactic and Clinical Medicine, Kyiv

Shaprynskyi V,. MD, Phd, Senior Researcher, Vascular surgeon
Research and Practical Centre of Preventive and Clinical Medicine, Kyiv, Ukraine
Email: vasyl.shaprynskyy@gmail.com
ORCID id:0000-0002-1437-7410

O. F. Dzygal, Odessa National Medical University

Dzygal Olexander Fedorovich, MD, DSci(Med), Associated Professor,
Department of Surgery N3 with neurosurgery,
Odessa National Medical University
Valikhovsky lane, 2, Odessa, 65026, Ukraine
050-3365050;
adzygal@eximneft.com
http://orcid.org/0000-0002-2281-1803

A. V. Shamray-Sas, Scientific-Practical Centre of Prophylactic and Clinical Medicine, Kyiv

A.V. Shamray-Sas MD, Phd, Senior Researcher, Vascular surgeon
Research and Practical Centre of Preventive and Clinical Medicine, Kyiv, Ukraine
Email: sa-sha-art@bigmir.net
ORCID id:0000-0003-4099-3118

A. M. Kucyn, Scientific-Practical Centre of Prophylactic and Clinical Medicine, Kyiv

Kucyn A.M. Vascular surgeon, Postgraduate Student,
Department of Minimally Invasive Surgery
Research and Practical Centre of Preventive and Clinical Medicine, Kyiv, Ukraine
Email: kutsyn.anton@gmail.com
ORCID id:0000-0001-9421-8032

References

Carmona GA, Hoffmeyer P, Herrmann FR, Vaucher J, Tschopp O, Lacraz A, et al. Major lower limb amputations in the elderly observed over ten years: the role of diabetes and peripheral arterial disease. Diabetes Metab. 2005; 31(5):449-54. PMID: 16357788 doi: 10.1016/s1262-3636(07)70215-x.

National diabetes audit executive summary 2009-10. [Internet]. The NHS Information Centre 2011. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit/national-diabetes-audit-2009-10.

Roglic G. WHO Global report on diabetes: A summary. Int J Noncommun Dis Jan 2016 1(1): 3-8. doi:10.4103/2468-8827.184853.

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl S):5-67. PMID: 17223489 doi: 10.1016/j.jvs.2006.12.037.

Halliday A, Bax JJ The 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in Collaboration With the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(3):301-2. doi: 10.1016/j.ejvs.2018.03.004. PMID: 29579461. doi:10.1016/j.ejvs.2018.03.004.

Aiello A, Anichini R, Brocco E, Caravaggi C, Chiavetta A, Cioni R, et al. Italian Society of Diabetes; Italian Society of Radiology; Italian Society of Vascular Endovascular Surgery. Treatment of peripheral rterial disease in diabetes: a of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE). Nutr Metab Cardiovasc Dis. 2014;24(4):355-69. PMID: 24486336. doi: 10.1016/j.numecd.2013.12.007.

Taylor GI The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg. 2003;30(3):331-42, v. PMID: 12916590. doi: 10.1016/s0094-1298(03)00034-8.

Manzi M, Cester G, Palena LM, Alek J, Candeo A, Ferraresi R. Vascular imaging of the foot: the first step toward endovascular recanalization. Radiographics. 2011;31(6):1623-36. doi: 10.1148/rg.316115511.

Huang TY, Huang TS, Wang YC, Huang PF, Yu HC, Yeh CH. Direct Revascularization With the Angiosome Concept for Lower Limb Ischemia: A Systematic Review and Meta-Analysis Medicine (Baltimore). 2015;94(34):e1427. doi: 10.1097/MD.0000000000001427.

Jongsma H, Bekken JA, Akkersdijk GP, Hoeks SE, Verhagen HJ, Fioole B Angiosome-directed revascularization in patients with critical limb ischemia J Vasc Surg. 2017;65(4):1208-19.e1. doi: 10.1016/j.jvs.2016.10.100.

Manzi M, Palena LM. Treating Calf and Pedal Vessel Disease: The Extremes of Intervention Semin Intervent Radiol. 2014;31(4):313-9. PMID: 25435656. doi: 10.1055/s-0034-1393967.

Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, et al. GVG Writing Group for the Joint Guidelines of the Society for Vascular Surgery (SVS), European Society for Vascular Surgery (ESVS), and World Federation of Vascular Societies (WFVS). Global Vascular Guidelines on the Management of Chronic Limb-Threating Ichemia Eur J Vasc Endovasc Surg. 2019;58(1S):1-109.e33. doi: 10.1016/j.ejvs.2019.05.006.

Iida O, Takahara M, Soga Y, Kodama A, Terashi H, Azuma N. Three-Year Outcomes of Surgical Versus Endovascular Revascularization for Critical Limb Ischemia The SPINACH Study (Surgical Reconstruction Versus Peripheral Intervention in Patients With Critical Limb Ischemia) on behalf of the SPINACH Investigators. J Atheroscler Thromb.2020 Mar 28. doi: 10.5551/jat.54866.

Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchliffe RJ, Lipsky BA; IWGDF Editorial Board. IWGDF Guidelines on the prevention and management of diabetic foot disease Diabetes Metab Res Rev.2020;36 Suppl 1:e3266. doi: 10.1002/dmrr.3266.

Published
2020-06-26
How to Cite
Gupalo, Y. M., Shapovalov, D. Y., Shaprynskyi, V. V., Dzygal, O. F., Shamray-Sas, A. V., & Kucyn, A. M. (2020). The angiosome concept in revascularization of the shin and foot arteries in patients with diabetes mellitus. Klinicheskaia Khirurgiia, 87(3-4), 55-58. https://doi.org/10.26779/2522-1396.2020.3-4.55
Section
General Problems of Surgery