Long-term results of direct and indirect endovascular revascularization based on the angiosome concept in patients with critical limb ischemia presenting.

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Presentation transcript:

Long-term results of direct and indirect endovascular revascularization based on the angiosome concept in patients with critical limb ischemia presenting with isolated below- the-knee lesions Osamu Iida, MD, Yoshimitsu Soga, MD, Keisuke Hirano, MD, Daizo Kawasaki, MD, Kenji Suzuki, MD, Yusuke Miyashita, MD, PhD, Hiroto Terashi, MD, PhD, Masaaki Uematsu, MD, PhD Journal of Vascular Surgery Volume 55, Issue 2, Pages 363-370.e5 (February 2012) DOI: 10.1016/j.jvs.2011.08.014 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 Angiosome concept. Six angiosomes of the foot and ankle are supplied by three main arteries. Left, The anterior tibial artery (ATA) becomes the dorsalis pedis artery that supplies the dorsum of the foot and dorsum side of the toes. Middle, Three main branches of the posterior tibial artery (PTA) supply distinct portions of the sole: the calcaneal branch to the heel, the medial plantar artery to the medial, and the lateral plantar artery to the lateral midfoot and the forefoot. The PTA supplies the plantar side of the toes, the web spaces between the toes, the sole of the foot, and the inside of the heel. Right, The peroneal artery (PA) supplies the lateral border of the ankle and the outside of the heel. Journal of Vascular Surgery 2012 55, 363-370.e5DOI: (10.1016/j.jvs.2011.08.014) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 Kaplan-Meier curves are shown for the amputation-free survival rate in the direct (blue line) and indirect (red line) groups after propensity matching analysis. The estimated amputation-free survival percentage and standard error (error bars) was 71% ± 4% in the direct group vs 50% ± 5% in the indirect group at 1 year, 58% ± 5% vs 41% ± 5% at 2 years, 58% ± 5% vs 36% ± 6% at 3 years, and 49% ± 8% vs 29% ± 6% at 4 years (P = .002), respectively. There was higher amputation-free survival in the direct group at all times. Journal of Vascular Surgery 2012 55, 363-370.e5DOI: (10.1016/j.jvs.2011.08.014) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 Kaplan-Meier curves are shown for the rate of freedom from major adverse limb event (MALE) in the direct (blue line) and indirect (red line) groups after propensity-matching analysis. Estimated freedom from MALE percentage and standard error (error bars) was 65% ± 5% in the direct group vs 55% ± 5% in the indirect group at 1 year, 61% ± 5% vs 47% ± 6% at 2 years, 56% ± 7% vs 44% ± 6% at 3 years, and 51% ± 8% vs 28% ± 8% at 4 years (P = .008), respectively. There was higher freedom from MALE in the direct group at all times. Journal of Vascular Surgery 2012 55, 363-370.e5DOI: (10.1016/j.jvs.2011.08.014) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 4 Kaplan-Meier curves are shown for the rate of freedom from major amputation in the direct (blue line) and indirect (red line) groups after propensity matching analysis. Estimated freedom from major amputation percentage and standard error (error bars) was 85% ± 4% in the direct group vs 74% ± 5% in the indirect group at 1 year and 82% ± 5% vs 68% ± 5% at 2, 3, and 4 years (P = .015), respectively. There was higher limb salvage rate in the direct group at all times. Journal of Vascular Surgery 2012 55, 363-370.e5DOI: (10.1016/j.jvs.2011.08.014) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 5 (online only) Kaplan-Meier curves are shown for unadjusted amputation-free survival (AFS) in the direct (blue line) and indirect (red line) groups. Unadjusted AFS percentage and standard error (error bars) was 67% ± 4% in the direct group vs 56% ± 4% in the indirect group at 1 year, 55% ± 4% vs 43% ± 5% at 2 years, 49% ± 5% vs 37% ± 6% at 3 years, and 39% ± 7% vs 30% ± 7% at 4 years (P = .04). There was higher AFS in the direct group at all times. Journal of Vascular Surgery 2012 55, 363-370.e5DOI: (10.1016/j.jvs.2011.08.014) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 6 (online only) Kaplan-Meier curves are shown for unadjusted freedom from major adverse limb event (MALE) in the direct (blue line) and indirect (red line) groups. Unadjusted freedom from MALE percentage and standard error (error bars) was 61% ± 4% in the direct group vs 54% ± 4% in the indirect group at 1 year, 55% ± 4% vs 47% ± 5% at 2 years, 49% ± 6% vs 44% ± 5% at 3 years, and 46% ± 6% vs 29% ± 8% at 4 years (P = .02). There was higher freedom from MALE in the direct group at all times. Journal of Vascular Surgery 2012 55, 363-370.e5DOI: (10.1016/j.jvs.2011.08.014) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 7 (online only) Kaplan-Meier curves are shown for unadjusted freedom from major amputation in the direct (blue line) and indirect (red line) groups. Unadjusted freedom from major amputation percentage and standard error (error bars) was 84% ± 3% in the direct group vs 76% ± 4% in the indirect group at 1 year, and 79% ± 4% vs 72% ± 4% at 2, 3 and 4 years, (P = .05). There was higher limb salvage rate in the direct group at all times. Journal of Vascular Surgery 2012 55, 363-370.e5DOI: (10.1016/j.jvs.2011.08.014) Copyright © 2012 Society for Vascular Surgery Terms and Conditions