Predictive value of angiographic scores for the integrated management of the ischemic diabetic foot Irene Bargellini, MD, Alberto Piaggesi, MD, Antonio.

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Presentation transcript:

Predictive value of angiographic scores for the integrated management of the ischemic diabetic foot Irene Bargellini, MD, Alberto Piaggesi, MD, Antonio Cicorelli, MD, Loredana Rizzo, MD, Rosa Cervelli, MD, Elisabetta Iacopi, MD, Alessandro Lunardi, MD, Roberto Cioni, MD Journal of Vascular Surgery Volume 57, Issue 5, Pages 1204-1212 (May 2013) DOI: 10.1016/j.jvs.2012.10.104 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 Male patient with D3 lesion of the forefoot extended to third, fourth, and fifth toe. The preprocedural angiographic images (A, thigh level; B, popliteal level; C, calf; D, foot) demonstrate no significant involvement of the femoropopliteal axis and occlusion at different levels of all three infrapopliteal arteries. Thus, patient was not classifiable according to TransAtlantic Inter-Society Consensus (TASC) II, and he was classified into Graziani's class 5, while the calf score was 10 (anterior tibial artery, 3; posterior tibial artery, 3; peroneal artery, 3) and the foot score was 10 (dorsalis pedis artery, 3; lateral plantar artery, 3; medial plantar artery, 3). Revascularization was attempted of the posterior tibial and peroneal arteries but failed to achieve a distal re-entry with adequate run-off. Therefore, the final angiographic control (E, calf; F, foot) was unchanged compared with the baseline acquisition. The patient underwent major amputation because of the extensive gangrene 4 days after the attempted revascularization. Journal of Vascular Surgery 2013 57, 1204-1212DOI: (10.1016/j.jvs.2012.10.104) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 A 64-year-old male patient, with D3 lesion of the third toe. According to the preprocedural angiographic images (A, thigh level; B, popliteal level; C, calf; D, foot), the patient was classified as TransAtlantic Inter-Society Consensus (TASC) II B (for the presence of a focal occlusion of the distal superficial femoral artery, arrow), Graziani's class 6, calf score 8 (anterior tibial artery, 2.5; posterior tibial artery, 2.5; peroneal artery, 2), and foot score 9 (dorsalis pedis artery, 2.5; lateral plantar artery, 3; medial plantar artery, 2.5). Journal of Vascular Surgery 2013 57, 1204-1212DOI: (10.1016/j.jvs.2012.10.104) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Same patient as Fig 2. The postprocedural angiographic images (A, thigh level; B, popliteal level; C, calf; D, foot) demonstrate recanalization of femoropopliteal axis and patency of the three calf arteries. Thus, the patient is not classifiable according to TransAtlantic Inter-Society Consensus (TASC) II, and he is in Graziani's class 0. The calf score is 1 (anterior tibial artery, 0; posterior tibial artery, 0; peroneal artery, 0), whereas the foot score is 6.5 (dorsalis pedis artery, 2.5; lateral plantar artery, 3; medial plantar artery, 0). Patient underwent minor amputation of the toe, with complete wound epithelization after 5 months. Journal of Vascular Surgery 2013 57, 1204-1212DOI: (10.1016/j.jvs.2012.10.104) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 Clinical success according to preprocedural and postprocedural calf and foot scores (box plot). Distribution of pre- and postprocedural calf and foot scores according to the clinical success. Only the foot scores were significantly related to wound healing (one-way analysis of variance). Journal of Vascular Surgery 2013 57, 1204-1212DOI: (10.1016/j.jvs.2012.10.104) Copyright © 2013 Society for Vascular Surgery Terms and Conditions