Article View – 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

Endovascular Management of Juxtarenal and Pararenal Abdominal Aortic Aneurysms: Role of Chimney Technique

Stefano Fazzini
Vascular Surgery Unit, Biomedicine and Prevention Department, Tor Vergata University, Rome, Ital

Valerio Turriziani
Vascular Surgery Unit, Biomedicine and Prevention Department, Tor Vergata University, Rome, Italy

Federico Francisco Pennetta
Vascular Surgery Unit, Biomedicine and Prevention Department, Tor Vergata University, Rome, Italy

Simona Vona
Vascular Surgery Unit, Biomedicine and Prevention Department, Tor Vergata University, Rome, Italy

Fabio Massimo Oddi
Vascular Surgery Unit, Biomedicine and Prevention Department, Tor Vergata University, Rome, Italy

Andrea Ascoli Marchetti
Vascular Surgery Unit, Biomedicine and Prevention Department, Tor Vergata University, Rome, Italy

Konstantinos P Donas
Department of Vascular Surgery and Research Vascular Centre, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany

Arnaldo Ippoliti
Vascular Surgery Unit, Biomedicine and Prevention Department, Tor Vergata University, Rome, Italy

Abstract

The use of chimney technique in endovascular repair of abdominal aortic aneurysms (ChEVAR) has had a secondary role. Although it was first developed in an emergent/urgent setting, the publication of various important studies has helped overcome scepticism towards this technique in elective procedures. This paper reviews current evidence about ChEVAR, focusing on clinical results, technical notes and comparisons with other techniques. The new ChEVAR findings show favourable mid- and long-term clinical outcomes, even in elective patients. These results, comparable to those related to fenestrated endografts, have been achieved through standardisation in planning and materials. An adequate endograft oversizing associated to the right aortic neck length is fundamental to avoid ChEVAR-related complications, such as type 1a endoleaks. These data indicate that ChEVAR, compared to other complex endovascular treatments, has comparable outcomes along with features that could make it an essential option in every clinical setting.

Keywords : Chimney endovascular aortic repair, chimney graft, juxtarenal abdominal aortic aneurysm, pararenal abdominal aortic aneurysm, endovascular aortic repair, fenestrated endovascular aortic repair, planning.

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