Vascular and Endovascular Review

VOLUME 6, 2023

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Is There a Difference in Patency Between Patients Undergoing Venous Stenting for Acute Deep Venous Thrombosis Following Thrombus Removal Versus Post-thrombotic Syndrome Stenoses?

Louis Rucker
Division of Vascular Surgery, TriHealth – Good Samaritan Hospital, Cincinnati, OH, US
Audrey Muck
Division of Vascular Surgery, TriHealth – Good Samaritan Hospital, Cincinnati, OH, US
Mark Broering
Division of Vascular Surgery, TriHealth – Good Samaritan Hospital, Cincinnati, OH, US
Patrick Muck
Division of Vascular Surgery, TriHealth – Good Samaritan Hospital, Cincinnati, OH, US

Abstract

Venous stenting was introduced in the 1990s and has continued to evolve to become the first-line therapy for symptomatic iliofemoral venous outflow pathology. There are several dedicated venous stents available in addition to Boston Scientific’s Wallstent and Cook’s Z-Stent. Numerous studies from tertiary referral centres, as well as industry-sponsored trials, have demonstrated the safety and efficacy of these endovascular devices for non-thrombotic iliac vein (NIVL) and post-thrombotic syndrome (PTS) lesions. Patients presenting with acute deep venous thrombosis (aDVT) may also undergo stenting following thrombus removal. The standard of care for NIVL, PTS and aDVT patients has become venography and intravascular ultrasound, and if an underlying iliofemoral stenosis is identified, a stent is placed. There is a concern that inflammation may affect the results of stenting in the aDVT population. Although endovascular stenting for acute venous diseases appears promising and safe, there is a paucity of data on efficacy in aDVT patients. There are only two industry-sponsored trials and a few publications and presentations at academic society meetings to examine. This review assesses the available results for endovascular stenting for aDVT and PTS patients, but not for NIVL.

Keywords : Stent, venous, deep venous thrombosis, iliocaval, femoral, iliac.
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.
Mark Yang
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty